Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Nov 18;89(6):1122-1131.
doi: 10.1093/neuros/nyab366.

Thrombus Histology as It Relates to Mechanical Thrombectomy: A Meta-Analysis and Systematic Review

Ankur Bhambri  1 , Arjun Rohit Adapa  2 , Yang Liu  3 , Tobias Boeckh-Behrens  4 , Václav Procházka  5 , Francisco Hernández-Fernández  6 , Rosa Angélica Barbella-Aponte  7 , Tetsuya Hashimoto  8 , Luis E Savastano  9 , Joseph J Gemmete  10 , Neeraj Chaudhary  10   11 , Albert J Shih  12 , Aditya S Pandey  10   11
Affiliations
Meta-Analysis

Thrombus Histology as It Relates to Mechanical Thrombectomy: A Meta-Analysis and Systematic Review

Ankur Bhambri et al. Neurosurgery. .

Abstract

Background: Appropriate thrombus-device interaction is critical for recanalization. Histology can serve as a proxy for mechanical properties, and thus inform technique selection.

Objective: To investigate the value of histologic characterization, we conducted a systematic review and meta-analysis on the relationship between thrombus histology and recanalization, technique, etiology, procedural efficiency, and imaging findings.

Methods: In this meta-analysis, we identified studies published between March 2010 and March 2020 reporting findings related to the histologic composition of thrombi in large vessel occlusion stroke. Studies with at least 10 patients who underwent mechanical thrombectomy using stent retriever or aspiration were considered. Only studies in which retrieved thrombi were histologically processed were included. Patient-level data were requested when data could not be directly extracted. The primary outcome assessed was the relationship between thrombus histology and angiographic outcome.

Results: A total of 22 studies encompassing 1623 patients met inclusion criteria. Clots associated with good angiographic outcome had higher red blood cell (RBC) content (mean difference [MD] 9.60%, 95% CI 3.85-15.34, P = .008). Thrombi retrieved by aspiration had less fibrin (MD -11.39, 95% CI -22.50 to -0.27, P = .046) than stent-retrieved thrombi. Fibrin/platelet-rich clots were associated with longer procedure times (MD 13.20, 95% CI 1.30-25.10, P = .037). Hyperdense artery sign was associated with higher RBC content (MD 14.17%, 95% CI 3.07-25.27, P = .027). No relationship was found between composition and etiology.

Conclusion: RBC-rich thrombi were associated with better recanalization outcomes and shorter procedure times, suggesting that preinterventional compositional characterization may yield important prognostic and therapeutic guidance.

Keywords: Clot; Histology; Ischemic stroke; Large vessel occlusion; Meta-analysis; Stent; Systematic review; Thrombectomy; Thrombus.

PubMed Disclaimer