Does Thrombus Equal Thrombus? Mechanical Characterization of Thrombi Retrieved During Endovascular Thrombectomy in Stroke Patients
Tolga D. Dittrich, MD
Boodt N, Snouckaert van Schauburg PRW, Hund HM, Fereidoonnezhad B, McGarry JP, Akyildiz AC, van Es ACGM, De Meyer SF, Dippel DWJ, Lingsma HF, et al. Mechanical Characterization of Thrombi Retrieved With Endovascular Thrombectomy in Patients With Acute Ischemic Stroke. Stroke. 2021;52:2510–2517.
Mechanical thrombectomy (MT) for acute stroke has made remarkable advances over the last few years. Despite technological improvements, revascularization still is not successful in a considerable fraction of treated patients. This inevitably raises the question of why MT is so difficult in some patients and how we might treat them better in the future.
An important starting point could be a more comprehensive understanding of the biological composition of thrombi and their mechanical properties. Experimental studies have shown that increasing thrombus stiffness is associated with unsuccessful or incomplete recanalization. For example, particularly stiff platelet-rich thrombi could not be removed by aspiration alone or combined with a stent retriever in an animal model.