Imaging stent-thrombus interaction in mechanical thrombectomy

A 52-year-old man had a right M1 occlusion, treated with mechanical intra-arterial therapy. After 5 minutes of intra-arterial embedding, the stentriever containing thrombus was retrieved, rinsed, and fixed for microscopy. MicroCT scanning electron and light microscopy was performed on the stentriever to assess stent–thrombus interaction (figure). Twenty-three sites of interaction between thrombus and stentriever were analyzed. Interaction was not mechanical at 12 of these sites. We observed fibrin cross-bridges connecting thrombus to stent wires. Fibrin also created smooth covers overlying erythrocyte-rich areas. Light microscopy further showed thrombus interspersed with leukocytes, consisting of fibrin- and platelet-rich areas coalescing around the stent wire.

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