Platelets; biomarker; endovascular therapy; first pass effect; thrombosis; Neurology (clinical); Cardiology and Cardiovascular Medicine
Abstract :
[en] [en] BACKGROUND AND PURPOSE: First pass effect (FPE), the occurrence of complete reperfusion after one pass with no rescue attempt during endovascular therapy (EVT), is associated with the best clinical outcome after an acute ischemic stroke (AIS). Previous studies evaluating FPE occurrence according to EVT technical strategies, occlusion locations, or thrombus composition have provided controversial results. Here, we performed a correlation analysis between FPE occurrence and AIS thrombus cellular composition, as assessed using quantitative biochemical assays.
PATIENTS AND METHODS: Homogenates of AIS thrombi from 250 patients were prepared by mechanical grinding. Platelet, red blood cell (RBC), and leukocyte contents of AIS thrombi were respectively estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. FPE was defined as a modified Thrombolysis in Cerebral Infraction (mTICI) score of 2C or 3 after a single EVT device pass.
RESULTS: AIS thrombi successfully removed after a single pass were poorer in GPVI (0.098 ± 0.023 vs 0.111 ± 0.024 ng/mg, p < 0.001) compared to those whose removal had required several passes. GPVI content was also significantly associated with a higher number of device passes and a longer procedure time. No such significant correlation was found with DNA and heme content.
DISCUSSION AND CONCLUSION: Thrombus platelet content may hamper thrombus removal by EVT. This result suggests that adjunctive therapies or functionalization of retrieval devices targeting platelets may improve EVT efficacy.
Disciplines :
Neurology
Author, co-author :
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
Di Meglio, Lucas; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
Consoli, Arturo; Interventional Neuroradiology Department, Hopital Foch, Suresnes, France
Nomenjanahary, Mialitiana Solo; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
Dupont, Sébastien; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
Labreuche, Julien; Department of Biostatistics, CHU Lille, Lille, France
Maier, Benjamin; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
Piotin, Michel; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
Blanc, Raphael; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
Escalard, Simon; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
Boursin, Perrine; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
Hamdani, Mylène; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
Redjem, Hocine; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
Smajda, Stanislas; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
Hébert, Solène; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
Sabben, Candice; Department of Neurology, Rothschild Foundation Hospital, Paris, France
de Noordhout, Alain Maertens; University of Liege, Liège, Belgium
Jandrot-Perrus, Martine; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
Lapergue, Bertrand; Department of Neurology, Hopital Foch, Suresnes, France
Mazighi, Mikael; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France ; Université de Paris, Paris, France ; FHU Neurovasc, Department of Neurology, Hopital Lariboisère, APHP Nord, Paris, France
Ho-Tin-Noé, Benoit; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France
Desilles, Jean-Philippe; Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, Paris, France ; Université de Paris, Paris, France
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: By public grants overseen by the French National Research Agency (ANR) as part of the investments for the future program (PIA) under grants agreement No. ANR-18-RHUS-0001 (RHU Booster).
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