The impact of occlusion location and bridging therapy in patients affected by acute ischemic stroke in determining the total number of passes required to remove the clot and the final revascularization outcome

Purpose Our purpose was to assess the impact of occlusion location in patients suffering from Acute Ischemic Stroke (AIS) on the total number of passes (attempts) necessary to retrieve the clot and on final revascularization outcome. Moreover, we analysed the impact of bridging-therapy, i.e. the concomitant use of IV tPA (intravenous tissue plasminogen activator) and mechanical thrombectomy (MT) on the different categories of occlusion locations. Methods 550 mechanically extracted thrombi were collected from four partner hospitals: Beaumont (Dublin) Sahlgrenska (Gothenburg), National Institute of Clinical Neurosciences (Budapest) and Metropolitan Hospital (Piraeus). In the vast majority of the cases (311 patients, 56.5%) the thrombus was located in the Middle Cerebral Artery (MCA), followed by Carotid Terminus/Internal Carotid Artery (ICA) in 89 cases (16.2%) and by vertebral/basilar artery (45 patients, 8.2%). In 65 cases (11.8%) a tandem occlusion, i.e. the occlusion of both ICA and MCA was found, while a dual occlusion occurred in 26 cases (4.7%). 248 patients (45.1%) underwent bridging-therapy, while 291 patients (52.9%) were treated with MT alone. For 11 patients (2%) we have no information whether tPA was administered or not. Recanalization rate was defined by using the modified Thrombolysis In Cerebral Infarction (mTICI) score. Non-parametric Kruskal-Wallis test using IBM SPSS-25 software was used for statistical analysis. Results Occlusion location had a significant impact on the total number of passes required to retrieve the clot as well as on final revascularization outcome. The cases with tandem and dual occlusion showed higher number of procedural passes and lower percentage of complete revascularizations (mTICI=3, Table 1). Bridging-therapy did not significantly reduce the total number of passes or improve the recanalization rates for patients with singular occlusion. On the other hand, bridging-therapy significantly lowered the total number of passes to remove the clot in patients with dual and tandem occlusion (N=87, mean for MT+tPA= 2.63±1.73, MT alone=3.80±2.14, H1=7.608, p=0.006*), but had no statistically significant effect on the final mTICI score (N=87, H1=0.266, p=0.606). Conclusion This study suggests that occlusion location significantly influences the total number of procedural passes in MT procedures as well as the final revascularization outcome. Furthermore, bridging-therapy lowers the number of procedural passes in cases of tandem and dual occlusion without having significant effect on final mTICI score. Funding: Science Foundation Ireland (Grant Number 13/RC/2073) and Cerenovus.Science Foundation Ireland (Grant Number 13/RC/2073) and Cerenovus.non-peer-reviewe

Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization

Introduction: We assessed the correlation between thrombus size before and after mechanical thrombectomy, measured as length by Computed Tomography Angiography/Non-Contrast Computed Tomography (CTA/NCCT) and Extracted Clot Area, ECA, respectively. We also assessed the influence of thrombus size on the number of passes required for clot removal and final recanalization outcome. Materials and methods: Acute ischaemic stroke (AIS) thrombi retrieved by mechanical thrombectomy from 500 patients and data of clot length by CTA/NCCT were collected from three hospitals in Europe. ECA was obtained by measuring the area of the extracted clot. Non-parametric tests were used for data analysis. Results: A strong positive correlation was found between clot length on CTA/NCCT and ECA (rho = 0.619,N = 500, P < 0.0001*). Vessel size influences clot length on CTA/NCCT (H2 = 98.6, P < 0.0001*) and ECA (H2 = 105.6,P < 0.0001*), but the significant correlation between CTA/NCCT length and ECA was evident in all vessels. Poorer revascularisation outcome was associated with more passes (H5 = 73.1, P < 0.0001*). More passes were required to remove longer clots (CTA/NCCT; H4 = 31.4, P < 0.0001*; ECA; H4 = 50.2, P < 0.0001*). There was no significant main association between recanalization outcome and length on CTA/NCCT or ECA, but medium sized clots (ECA 20-40 mm(2)) were associated with least passes and highest revascularisation outcome (N = 500, X-2 = 16.2, P < 0.0001*). Conclusion: Clot length on CTA/NCCT strongly correlates with ECA. Occlusion location influences clot size. More passes are associated with poorer revascularisation outcome and bigger clots. The relationship between size and revascularisation outcome is more complex. Clots of medium ECA take less passes to remove and are associated with better recanalization outcome than both smaller and larger clots

3D Bioprinting of Biosynthetic Nanocellulose-Filled GelMA Inks Highly Reliable for Soft Tissue-Oriented Constructs

Bioink-formulations based on gelatin methacrylate combined with oxidized cellulose nanofibrils are employed in the present study. The parallel investigation of the printing performance, morphological, swelling, and biological properties of the newly developed hydrogels was performed, with inks prepared using methacrylamide-modified gelatins of fish or bovine origin. Scaffolds with versatile and well-defined internal structure and high shape fidelity were successfully printed due to the high viscosity and shear-thinning behavior of formulated inks and then photo-crosslinked. The biocompatibility of 3D-scaffolds was surveyed using human adipose stem cells (hASCs) and high viability and proliferation rates were obtained when in contact with the biomaterial. Furthermore, bioprinting tests were performed with hASCs embedded in the developed formulations. The results demonstrated that the designed inks are a versatile toolkit for 3D bioprinting and further show the benefits of using fish-derived gelatin for biofabrication

Does bridging therapy in mechanical thrombectomy increase recanalization rates in ischemic stroke patients affected by acute large vessel occlusion?

Both intravenous thrombolysis with tissue plasminogen activator (IV-rtPA) and mechanical thrombectomy (MT) increase recanalization rates. We assessed if bridging-therapy (the concomitant use of rtPA and MT) could increase the recanalization rates and reduce the number of procedural passes in patients suffering from acute ischemic stroke (AIS) when compared to MT alone. Analysis of type of device used, stentriever or aspiration catheter, is also reported. 334 mechanically extracted thrombi were collected from two partner hospitals: Beaumont (Dublin) and Sahlgrenska (Gothenburg). 158 patients (47.3%) were treated with bridging-therapy, while 176 (52.7%) underwent MT alone. Recanalization rate was defined by using the modified Thrombolysis In Cerebral Infarction (mTICI) score. Non-parametric Kruskal-Wallis test was used for statistical analysis. Bridging-therapy reduced the total number of passes to remove the clot (mean for MT+rtPA=2.27±2.10, MT alone=2.63±1.88, H1=4.376, p=0.036*). Analysing the device, rtPA lowered the overall number of passes using stentriever devices (mean for MT+rtPA=1.57±1.12, MT alone=2.36±1.48, H1=8.303, p=0.004*), but not for aspiration (mean for MT+rt-PA=1.78±1.22, MT alone=2.03±1.47, for H1=0.795, p=0.372). Also, when using both devices no significant reduction of number of passes was observed (mean for MT+rtPA=3.29±2.90, MT alone=3.83±2.20, H1=3.027, p=0.082). There was no significant effect on final mTICI score using bridging-therapy when compared to MT alone (H1=1.163, p=0.281). This small study suggests that bridging-therapy lowers the number of procedural passes in MT procedures, specifically when using stentriever devices. However, this did not have a significant effect on final mTICI score. Funding: Science Foundation Ireland (Grant Number 13/RC/2073) and Cerenovus.Funding: Science Foundation Ireland (Grant Number 13/RC/2073) and Cerenovus.non-peer-reviewe

Platelet-rich emboli are associated with von Willebrand factor levels and have poorer revascularization outcomes

Background and aims Platelets and von Willebrand factor (vWF) are key factors in thrombosis and thus are likely key components of acute ischemic stroke (AIS) emboli. We aimed to characterize platelet and vWF levels in AIS emboli and to assess associations between their expression levels and clinical and procedural information. Materials and method Histopathological and immunohistochemical analysis of emboli collected as part of the multi-institutional RESTORE registry was performed. The composition of the emboli was quantified using Orbit Image Analysis machine learning software. Correlations between clot components and clinical and procedural information were assessed using the χ2 test. Results Ninety-one emboli samples retrieved from 63 patients were analyzed in the study. The mean platelet (CD42b) content of the clots was 33.9% and the mean vWF content of the clots was 29.8%. There was a positive correlation between platelet and vWF levels (ρ=0.564, p<0.001*, n=91). There was an inverse correlation between both platelets and vWF levels and percentage of red blood cells (RBCs) in the emboli (CD42b vs RBC: ρ=−0.535, p<0.001*, n=91; vWF vs RBC: ρ=−0.366, p<0.001*, n=91). Eighty-one percent of patients in the low platelet group had a good revascularization outcome (Thrombolysis in Cerebral Infarction 2c/3) compared with 58% in the high platelet group (χ2=5.856, p=0.016). Conclusion Platelet and vWF levels in AIS emboli correlate with each other and both have an inverse relationship with RBC composition. Patients with platelet-rich clots have poorer revascularization outcomes.peer-reviewe

Helium Atmospheric Pressure Plasma Jet Effects on Two Cultivars of <i>Triticum aestivum</i> L.

The use of cold plasma in the treatment of seeds before sowing presents a promising technique for sustainable agriculture. The objective of this study is to evaluate the effect of cold plasma treatment on the morphology of wheat seeds (Triticum aestivum L. ‘Dacic’ and ‘Otilia’), their germination, biochemical composition, and the nutritional quality of wheat grass. Wheat seeds were morphologically and elementally characterized by atomic force microscopy (AFM), scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM-EDX), X-ray computer tomography (CT), and particle-induced X-ray emission (PIXE). Helium was used as a working gas for plasma generation and the analysis of the species produced showed the presence of NOγ, OH, N2 and N2+ and O. Evaluation of germination and plant growth for 10 days (wheat grass stage) highlighted a specific trend for each cultivar. The biochemical analysis of wheat grass highlighted an increase in the chlorophyll content in the plasma-treated variants, an increase in the flavonoid and polyphenol content in ‘Dacic’-treated variant, while the soluble protein content, antioxidant activity, and color were not affected. The analysis of the nutritional quality of wheat grass by the FT-NIR analytical technique highlighted an increase in the ash content in the plasma-treated wheat cultivars, while the humidity, proteins, neutral detergent fiber (NDF), acid detergent fiber (ADF), and energy values were not affected

The impact of occlusion location and bridging therapy in patients affected by acute ischemic stroke in determining the total number of passes required to remove the clot and the final revascularization outcome

Purpose Our purpose was to assess the impact of occlusion location in patients suffering from Acute Ischemic Stroke (AIS) on the total number of passes (attempts) necessary to retrieve the clot and on final revascularization outcome. Moreover, we analysed the impact of bridging-therapy, i.e. the concomitant use of IV tPA (intravenous tissue plasminogen activator) and mechanical thrombectomy (MT) on the different categories of occlusion locations. Methods 550 mechanically extracted thrombi were collected from four partner hospitals: Beaumont (Dublin) Sahlgrenska (Gothenburg), National Institute of Clinical Neurosciences (Budapest) and Metropolitan Hospital (Piraeus). In the vast majority of the cases (311 patients, 56.5%) the thrombus was located in the Middle Cerebral Artery (MCA), followed by Carotid Terminus/Internal Carotid Artery (ICA) in 89 cases (16.2%) and by vertebral/basilar artery (45 patients, 8.2%). In 65 cases (11.8%) a tandem occlusion, i.e. the occlusion of both ICA and MCA was found, while a dual occlusion occurred in 26 cases (4.7%). 248 patients (45.1%) underwent bridging-therapy, while 291 patients (52.9%) were treated with MT alone. For 11 patients (2%) we have no information whether tPA was administered or not. Recanalization rate was defined by using the modified Thrombolysis In Cerebral Infarction (mTICI) score. Non-parametric Kruskal-Wallis test using IBM SPSS-25 software was used for statistical analysis. Results Occlusion location had a significant impact on the total number of passes required to retrieve the clot as well as on final revascularization outcome. The cases with tandem and dual occlusion showed higher number of procedural passes and lower percentage of complete revascularizations (mTICI=3, Table 1). Bridging-therapy did not significantly reduce the total number of passes or improve the recanalization rates for patients with singular occlusion. On the other hand, bridging-therapy significantly lowered the total number of passes to remove the clot in patients with dual and tandem occlusion (N=87, mean for MT+tPA= 2.63±1.73, MT alone=3.80±2.14, H1=7.608, p=0.006*), but had no statistically significant effect on the final mTICI score (N=87, H1=0.266, p=0.606). Conclusion This study suggests that occlusion location significantly influences the total number of procedural passes in MT procedures as well as the final revascularization outcome. Furthermore, bridging-therapy lowers the number of procedural passes in cases of tandem and dual occlusion without having significant effect on final mTICI score. Funding: Science Foundation Ireland (Grant Number 13/RC/2073) and Cerenovus.Science Foundation Ireland (Grant Number 13/RC/2073) and Cerenovus

Paramedic acute stroke treatment assessment (Pasta) trial: Main results

Introduction: Lipid accumulation and inflammation are considered hallmarks of the unstable atherosclerotic plaque. In particular, adipocyte fatty acid binding protein (FABP4) expression within the plaque is associated with its progression and vulnerability. The aim of this study was to investigate the histopathology of thrombi collected from acute ischaemic stroke patients who underwent mechanical thrombectomy focusing on the presence of FABP4 and other atherosclerotic plaque components, including collagen and dystrophic calcification. Methods: 250 mechanically extracted thrombi were collected from three partner hospitals: Beaumont Hospital (Dublin, Ireland), Sahlgrenska University Hospital (Gothenburg, Sweden) and Mayo Clinic (Rochester, Minnesota, USA). Clots were immediately formalin-fixed and embedded in paraffin. 3-µm thickness serial sections were cut and stained with Martius Scarlett Blue to identify erythrocytes, fibrin, white blood cells and platelets/other. Masson s and von Kossa stains were performed to identify collagen and calcification, respectively. The expression of FABP4 was assessed by immunofluorescence. Results: FABP4 expression by adipocytes was confirmed in eight of 250 clots (3.2%). Adipocytes represented the main component in one white clot. Collagen was associated in two cases whereas von Kossa staining showed calcification in one case. Conclusions: The expression of potentially atherogenic components in these clots suggests that they may have originated from large vessel occlusions. Further studies are required to confirm the atherosclerotic aetiology. Our findings have implications for neurointervention and therapeutic strategies to reduce atherosclerotic plaque progression and stroke recurrence.Science Foundation Ireland (Grant Number 13/RC/2073) and Cerenovus.non-peer-reviewe