Thrombectomy of calcified emboli in stroke. Does histology of thrombi influence the effectiveness of thrombectomy?

Dobrocky, Tomas; Piechowiak, Eike; Cianfoni, Alessandro; Zibold, Felix; Roccatagliata, Luca; Mosimann, Pascal; Jung, Simon; Fischer, Urs; Mordasini, Pasquale; Gralla, Jan (2018). Thrombectomy of calcified emboli in stroke. Does histology of thrombi influence the effectiveness of thrombectomy? Journal of neurointerventional surgery, 10(4), pp. 345-350. BMJ Publishing Group 10.1136/neurintsurg-2017-013226

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BACKGROUND AND PURPOSE Thrombus composition has been postulated to affect the success of endovascular therapy. Calcified clots are composed of large amounts of calcium phosphate which influences their mechanical properties and may serve as a model for testing this hypothesis. The aim of this study was to evaluate the recanalization and complication rates of calcified thromboemboli in patients with acute ischemic stroke who underwent thrombectomy. MATERIAL AND METHODS A retrospective analysis was performed of all calcified intracranial thromboemboli in patients suffering an acute ischemic stroke, referred for endovascular therapy at two centers between January 2013 and July 2016. RESULTS Eight patients with a calcified intracranial clot underwent stent retriever thrombectomy (five women; mean age 80 years). Mean clot attenuation was 305 HU (range 150-640 HU). Successful reperfusion defined, as Thrombolysis in Cerebral Infarction grade 2b-3 was achieved in only one patient (12.5%). Two periprocedural adverse events occurred: one peripheral vessel perforation which was coiled and one inadvertent stent retriever detachment due to fracture of the stent retriever wire. CONCLUSION Stent retriever thrombectomy of calcified thromboemboli seems less effective than with other types of clots. Different mechanical properties of calcified clots may render them stiffer and less accessible for stent retrievers. When faced with a calcified intracranial thromboembolus in clinical practice, a more contained approach may be warranted in view of low recanalization rates, and the potential for periprocedural adverse events.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie

UniBE Contributor:

Jung, Simon; Fischer, Urs; Mordasini, Pasquale and Gralla, Jan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1759-8486

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

30 Oct 2017 11:11

Last Modified:

21 Mar 2018 01:30

Publisher DOI:

10.1136/neurintsurg-2017-013226

PubMed ID:

28798266

Uncontrolled Keywords:

aneurysm angiography fistula intervention stroke

BORIS DOI:

10.7892/boris.104899

URI:

https://boris.unibe.ch/id/eprint/104899

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