Analyses of thrombi in acute ischemic stroke: A consensus statement on current knowledge and future directions
Por:
De Meyer, SF, Andersson, T, Baxter, B, Bendszus, M, Brouwer, P, Brinjikji, W, Campbell, BCV, Costalat, V, Davalos, A, Demchuk, A, Dippel, D, Fiehler, J, Fischer, U, Gilvarry, M, Gounis, MJ, Gralla, J, Jansen, O, Jovin, T, Kallmes, D, Khatri, P, Lees, KR, Lopez-Cancio, E, Majoie, C, Marquering, H, Narata, AP, Nogueira, R, Ringleb, P, Siddiqui, A, Szikora, I, Vale, D, von Kummer, R, Yoo, AJ, Hacke, W and Liebeskind, DS
Publicada:
1 ago 2017
Categoría:
Neurology
Resumen:
Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention. Current imaging techniques can provide some information about thrombi, but there remains much to evaluate about relationships that may exist among thrombus composition, occlusion characteristics and treatment outcomes. Improved pathophysiological characterization of clot types, their properties and how these properties change over time, together with clinical correlates from ongoing studies, may facilitate revascularization with thrombolysis and thrombectomy. Interdisciplinary approaches covering clinical, engineering and scientific aspects of thrombus research will be key to advancing the understanding of thrombi and improving acute ischemic stroke therapy. This consensus statement integrates recent research on clots and thrombi retrieved from cerebral arteries and provides a rationale for further analyses, including current opportunities and limitations.
Filiaciones:
De Meyer, SF:
Katholieke Univ Leuven, Lab Thrombosis Res, Campus Kulak Kortrijk, Kortrijk, Belgium
Andersson, T:
Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden
Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden
AZ Groeninge, Dept Med Imaging, Kortrijk, Belgium
Baxter, B:
Univ Tennessee, Dept Radiol, Erlanger Hosp, Chattanooga, TN USA
Bendszus, M:
Heidelberg Univ, Dept Neuroradiol, Heidelberg, Germany
Brouwer, P:
Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden
Brinjikji, W:
Mayo Clin, Dept Radiol, Rochester, MN USA
Campbell, BCV:
Univ Melbourne, Royal Melbourne Hosp, Dept Med & Neurol, Melbourne Brain Ctr, Grattan St, Parkville, Vic 3050, Australia
Costalat, V:
Montpellier Univ Hosp, Intervent & Diagnost Neuroradiol, Montpellier, France
:
Hosp Badalona Germans Trias & Pujol, Dept Neurosci, Acute Stroke Unit, Barcelona, Spain
Demchuk, A:
Univ Calgary, Cumming Sch Med, Dept Clin Neurosci & Radiol, Calgary, AB, Canada
Dippel, D:
Erasmus Univ, Dept Neurol, Med Ctr, Rotterdam, Netherlands
Fiehler, J:
Univ Med Ctr, Dept Neuroradiol, Hamburg, Germany
Fischer, U:
Univ Bern, Univ Hosp Bern, Dept Neurol, Inselspital, Bern, Switzerland
Gilvarry, M:
Neuravi Ltd, Neuravi Thromboembol Initiat, Galway, Ireland
Gounis, MJ:
Univ Massachusetts, Sch Med, Div Neuroimaging & Intervent, Worcester, MA USA
Univ Massachusetts, Sch Med, New England Ctr Stroke Res, Dept Radiol, Worcester, MA USA
Gralla, J:
Univ Bern, Univ Hosp Bern, Inst Diagnost & Intervent Neuroradiol, Inselspital, Bern, Switzerland
Jansen, O:
UKSH, Dept Radiol & Neuroradiol, Kiel, Germany
Jovin, T:
Univ Pittsburgh, Med Ctr, Dept Neurol, Pittsburgh, PA USA
Kallmes, D:
Mayo Clin, Dept Radiol, Rochester, MN USA
Khatri, P:
Univ Cincinnati, Dept Neurol, Cincinnati, OH USA
Lees, KR:
Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Scotland
Lopez-Cancio, E:
Hosp Badalona Germans Trias & Pujol, Dept Neurosci, Acute Stroke Unit, Barcelona, Spain
Majoie, C:
Acad Med Ctr, Dept Radiol, Amsterdam, Netherlands
Marquering, H:
Acad Med Ctr, Dept Radiol, Amsterdam, Netherlands
Acad Med Ctr, Dept Biomed Engn & Phys, Amsterdam, Netherlands
Narata, AP:
CHRU Hop Tours, Dept Neuroradiol, Tours, France
Nogueira, R:
Emory Univ, Dept Neurol, Atlanta, GA USA
Ringleb, P:
Heidelberg Univ, Dept Neurol, Heidelberg, Germany
Siddiqui, A:
SUNY Buffalo, Dept Neurosurg, Buffalo, NY USA
Szikora, I:
Natl Inst Neurosci, Dept Neuroradiol, Budapest, Hungary
Vale, D:
Neuravi Ltd, Neuravi Thromboembol Initiat, Galway, Ireland
von Kummer, R:
Univ Klinikum Carl Gustav Carus, Dresden, Germany
Yoo, AJ:
Texas Stroke Inst, Dallas, TX USA
Hacke, W:
Ruprecht Karls Univ Heidelberg, Univ Heidelberg Hosp, Dept Neurol, Heidelberg, Germany
Liebeskind, DS:
Univ Calif Los Angeles, Neurovasc Imaging Res Core, Los Angeles, CA USA
Univ Calif Los Angeles, Stroke Ctr, Los Angeles, CA USA
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