PMID- 33959088
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210508
IS  - 1664-2295 (Print)
IS  - 1664-2295 (Electronic)
IS  - 1664-2295 (Linking)
VI  - 12
DP  - 2021
TI  - Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical 
      Significance in a Mechanical Thrombectomy Series.
PG  - 631343
LID - 10.3389/fneur.2021.631343 [doi]
LID - 631343
AB  - Introduction: The histological composition of the clot influences its mechanical 
      properties, affects the efficacy of endovascular treatment (EVT), and could 
      determine the clinical outcome of patients with acute ischemic stroke (AIS). 
      Insights into clot composition may guide therapeutic decision-making prior to EVT 
      and facilitate revascularization therapies. Material and Methods: Consecutive 
      patients with AIS recorded in a prospective single-center reperfusion registry 
      from December 2015 to December 2019 and treated with EVT were included. Baseline, 
      laboratory [including post-procedural C-reactive protein (CRP)], radiological, 
      and angiographic variables were analyzed. We aimed to study the relationship 
      between histological composition of the clot with basal neuroimaging, laboratory 
      markers, and recanalization technique. The secondary outcome was to analyze the 
      correlation between clot composition and functional outcome at 3 months assessed 
      by the modified Rankin scale (mRS). Results: From the study period, 360 AIS 
      patients treated with EVT were included, of whom 189 (53%) fulfilled the 
      inclusion criteria. One hundred (53%) cases of fibrin-predominant clot (FPC) were 
      recorded. Full recanalization in FPC cases was achieved with higher probability 
      when stent retrievers (SR) were selected as the first-line device (68.2%, p = 
      0.039). Patients with FPC had higher levels of CRP (p = 0.02), lower frequency of 
      the hyperdense middle cerebral artery (HMCA) in baseline imaging (p = 0.039), and 
      higher rates of mortality (p = 0.012). The multivariate analysis showed that the 
      absence of HMCA (OR = 0.420; 95% CI 0.197-0.898; p = 0.025) and higher levels of 
      CRP (OR = 1.01; 95% CI 1.003-1.019; p = 0.008) were predictors of FPC. Leukocytes 
      and platelet counts were not associated with clot histology. Conclusions: The 
      absence of HMCA and higher levels of CRP were markers of FPC. In patients with 
      FPC, complete recanalization was most likely to be achieved when a SR was 
      selected as first line of treatment. Mortality was higher in patients within this 
      histologic group.
CI  - Copyright (c) 2021 Hernandez-Fernandez, Ramos-Araque, Barbella-Aponte, 
      Molina-Nuevo, Garcia-Garcia, Ayo-Martin, Pedrosa-Jimenez, Lopez-Martinez, 
      Serrano-Heras, Julia-Molla and Segura.
FAU - Hernandez-Fernandez, Francisco
AU  - Hernandez-Fernandez F
AD  - Department of Neurology, Hospital General Universitario de Albacete, Albacete, 
      Spain.
FAU - Ramos-Araque, Maria E
AU  - Ramos-Araque ME
AD  - Department of Neurology, University Hospital of Salamanca, Biomedical Research 
      Institute of Salamanca, Salamanca, Spain.
AD  - Department of Neurology, University Hospital of Valladolid, Valladolid, Spain.
FAU - Barbella-Aponte, Rosa
AU  - Barbella-Aponte R
AD  - Department of Surgical Pathology, Hospital General Universitario de Albacete, 
      Albacete, Spain.
FAU - Molina-Nuevo, Juan David
AU  - Molina-Nuevo JD
AD  - Department of Radiology, Hospital General Universitario de Albacete, Albacete, 
      Spain.
FAU - Garcia-Garcia, Jorge
AU  - Garcia-Garcia J
AD  - Department of Neurology, Hospital General Universitario de Albacete, Albacete, 
      Spain.
FAU - Ayo-Martin, Oscar
AU  - Ayo-Martin O
AD  - Department of Neurology, Hospital General Universitario de Albacete, Albacete, 
      Spain.
FAU - Pedrosa-Jimenez, Maria Jose
AU  - Pedrosa-Jimenez MJ
AD  - Department of Radiology, Hospital General Universitario de Albacete, Albacete, 
      Spain.
FAU - Lopez-Martinez, Lorena
AU  - Lopez-Martinez L
AD  - Department of Radiology, Hospital General Universitario de Albacete, Albacete, 
      Spain.
FAU - Serrano-Heras, Gemma
AU  - Serrano-Heras G
AD  - Research Unit, Hospital General Universitario de Albacete, Albacete, Spain.
FAU - Julia-Molla, Enrique
AU  - Julia-Molla E
AD  - Department of Radiology, Hospital General Universitario de Albacete, Albacete, 
      Spain.
FAU - Segura, Tomas
AU  - Segura T
AD  - Department of Neurology, Hospital General Universitario de Albacete, Albacete, 
      Spain.
AD  - Instituto de Investigacion en Discapacidades Neurologicas (IDINE), Facultad de 
      Medicina, Universidad de Castilla-La Mancha, Albacete, Spain.
LA  - eng
PT  - Journal Article
DEP - 20210420
PL  - Switzerland
TA  - Front Neurol
JT  - Frontiers in neurology
JID - 101546899
PMC - PMC8093432
OTO - NOTNLM
OT  - fibrin
OT  - mortality
OT  - stroke
OT  - thrombectomy
OT  - thrombolysis (tPA)
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/05/08 06:00
MHDA- 2021/05/08 06:01
PMCR- 2021/04/20
CRDT- 2021/05/07 07:10
PHST- 2020/11/19 00:00 [received]
PHST- 2021/03/09 00:00 [accepted]
PHST- 2021/05/07 07:10 [entrez]
PHST- 2021/05/08 06:00 [pubmed]
PHST- 2021/05/08 06:01 [medline]
PHST- 2021/04/20 00:00 [pmc-release]
AID - 10.3389/fneur.2021.631343 [doi]
PST - epublish
SO  - Front Neurol. 2021 Apr 20;12:631343. doi: 10.3389/fneur.2021.631343. eCollection 
      2021.