Modeling Large Vessel Occlusion Stroke for the Evaluation of Endovascular Therapy According to Thrombus Composition.
Modeling Large Vessel Occlusion Stroke for the Evaluation of Endovascular Therapy According to Thrombus Composition.
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DOI：
10.3389/fneur.2021.815814
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发表时间：
2021
影响因子：
3.4
通讯作者：
Désilles JP
中科院分区：
文献类型：
--
作者：
Freiherr von Seckendorff A;Delvoye F;Levant P;Solo Nomenjanahary M;Ollivier V;Bourrienne MC;Di Meglio L;Piotin M;Escalard S;Maier B;Hebert S;Smajda S;Redjem H;Mazighi M;Blanc R;Ho-Tin-Noé B;Désilles JP
超过 40% 的血管内治疗 (EVT) 无法实现急性缺血性卒中 (AIS) 患者闭塞动脉区域的完全再灌注。了解影响 EVT 的因素有助于克服其局限性。我们的目标是研究血栓细胞组成对 EVT 程序的影响，使用模拟系统对血流条件下血栓引起的大血管闭塞 (LVO) 进行建模。在一项开放比较试验中，我们分析了在模拟支架取回器介导的 EVT 过程中，尺寸标准化的富含血小板和富含红细胞 (RBC) 的血栓的行为。进行了 16 次模拟 EVT 手术（8 例红细胞血栓与 8 例富含血小板的血栓）。与富含红细胞的血栓相比，富含血小板的血栓与更多的支架回收器通过次数（p = 0.03）和更长的手术持续时间（p = 0.02）相关。相反，富含红细胞的血栓比富含血小板的血栓释放更多的栓塞碎片（p = 0.004）。富含红细胞和富含血小板的血栓在注射到体外循环模型后都经历了剧烈的压实，组织学分析表明，这些 EVT 回收的血栓表现出与之前在患有 LVO 的 AIS 患者的血栓中观察到的特征相当，包括富含红细胞和富含血小板区域之间的明显结构二分性。我们的结果表明，在人工脑血管动脉网络中注射体外产生的血栓适用于测试再通效果以及与血栓细胞成分相关的 EVT 装置和策略的栓塞风险。
More than 40% of endovascular therapy (EVT) fail to achieve complete reperfusion of the territory of the occluded artery in patients with acute ischemic stroke (AIS). Understanding factors influencing EVT could help overcome its limitations. Our objective was to study the impact of thrombus cell composition on EVT procedures, using a simulation system for modeling thrombus-induced large vessel occlusion (LVO) in flow conditions. In an open comparative trial, we analyzed the behavior of size-standardized platelet-rich and red blood cells (RBC)-rich thrombi during simulated stent retriever-mediated EVT procedures. Sixteen simulated EVT procedures were performed (8 RBC- vs. 8 platelet-rich thrombi). Platelet-rich thrombi were associated with a higher number of stent retriever passes (p = 0.03) and a longer procedure duration (p = 0.02) compared to RBC-rich thrombi. Conversely, RBC-rich thrombi released more embolic fragments than platelet-rich thrombi (p = 0.004). Both RBC-rich and platelet-rich thrombi underwent drastic compaction after being injected into the in vitro circulation model, and histologic analyses showed that these EVT-retrieved thrombi displayed features comparable to those previously observed in thrombi from patients with AIS patients having LVO, including a marked structural dichotomy between RBC- and platelet-rich areas. Our results show that the injection of in vitro-produced thrombi in artificial cerebrovascular arterial networks is suitable for testing recanalization efficacy and the risk of embolization of EVT devices and strategies in association with thrombus cell composition.
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作者：
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通讯作者：
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作者：
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10.1055/a-0998-4246
发表时间：
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