Literature Review

Risk of thrombus fragmentation during endovascular stroke treatment

Selected in American Journal of Neuroradiology by JITTAPIROMSAK Pakrit

Authors: Kaesmacher J, Boeckh-Behrens T, Simon S, Maegerlein C, Kleine JF, Zimmer C, Schirmer L, Poppert H, Huber T

Reference: AJNR Am J Neuroradiol. 2017 May;38(5):991-998

Published: May 2017

Rate it
Wednesday 31 May 2017
Pakrit Jittapiromsak

Mechanical thrombectomy may be the cause of distal emboli during procedure resulting in demoted effectiveness in recanalisation. Identification of risk factors may improve the results of this procedure.

The authors reviewed 85 cases of anterior circulation strokes with successfully retrieved clot by thrombectomy. They correlated younger age, easy–to-retrieve thrombi, and bridging thrombolysis as significant risk factors for periprocedural fragmentation. Higher amounts of neutrophil elastase positive cells in the thrombus were also associated with multiple emboli.

The results are reasonable, however, an interpretation of these results should be done cautiously. When the clot is interpreted as easy to retrieve, we usually do not spend extra-time for minor distal emboli as statistically found in this study. When the clot is interpreted as difficult, there could be much more cases with remained distal emboli which are excluded by this study (no clot successfully retrieved). The results of clot histology are marginally significant/non-significant. This amount of retrieved proximal clot may not represent any risk for distal emboli.

Please log in to react and view comments
More Reviews

On the same subject:


The power of clinical evidence


Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a meta-analysis


Time for a time window extension: Insights from late presenters in the ESCAPE trial


The new challenges for stroke treatment


MEDTRONIC: Going beyond devices to the patients