Document resource
Introduction Mechanical thrombectomy (MT) is the standard of care for ischemic stroke patients with large vessel occlusion eligible for endovascular therapy.1 In a previous study, we introduced high-field ‘MR microscopy’ to characterize clot composition and showed that white clots are associated with more recanalization attempts, longer procedure times, and worse clinical outcomes.2 This study focuses on clots that are particularly difficult to retrieve, commonly referred to as ‘tough clots’.Aim of Study This study aims to elucidate the procedural challenges posed by ‘tough clots’, assess their clinical relevance, and investigate the impact of clot composition on recanalization success and patient outcomes.Method We conducted a prospective, non-randomized, single-center study analyzing clot composition in 33 ischemic stroke patients undergoing mechanical thrombectomy. Ex vivo assessment using 9.4T MR microscopy (including relaxometry) enabled 3D reconstruction and volumetric analysis with Slicer software. In 28 cases, histopathological validation was performed. Imaging findings were correlated with pre-interventional CT (focusing on the hyperdense artery sign) and clinical parameters.Abstract A116 Figure 1Results ‘MR microscopy’ is highly accurate in differentiating different clot types. We identified red blood cell-rich (10,71% of clots), mixed clots (28,57%) and platelet-rich (white, 60,71%) as distinct morphological patterns. The correlation between the relaxometric times (T2, T2 *, T1) and HAS shows significant differences amongst the beforementioned clot types.Abstract A116 Figure 2Conclusion This study characterizes the composition of retrieved tough clots following mechanical thrombectomy using multimodal quantitative imaging, including MRI-based 3D reconstruction. By exploring the relationship between clot composition, stroke etiology, and clinical outcomes, we aim to support more personalized treatment strategies for patients undergoing thrombectomy.Conflict of Interest No