Sahin Cansu, Giraud Alice, Sak Nazan Güner, Liu Wenyi, Messina Pierluca, Bozsak Franz, Darcourt Jean, Sacchetti Federico, Januel Anne-Christine, Bellanger Guillaume, Pagola Jorge, Juega Jesus, Imamura Hirotoshi, Ohta Tsuyoshi, Spelle Laurent, Chalumeau Vanessa, Mircic Uros, Stanarcevic Predrag D, Vukasinovic Ivan, Ribo Marc, Sakai Nobuyuki, Cognard Christophe, Doyle Karen
CÚRAM Research Ireland Centre for Medical Devices, University of Galway, Galway, County Galway, Ireland.
Department of Physiology, University of Galway, Galway, County Galway, Ireland.
J Neurointerv Surg. 2025 Jul 15. doi: 10.1136/jnis-2025-023658.
Clot composition plays a key role in the pathophysiology of Acute Ischemic Stroke (AIS) and impacts the effectiveness of treatments such as thrombolysis and mechanical thrombectomy (MT). Developing an electrochemical impedance spectroscopy (EIS) based device to identify clot characteristics could improve stroke treatment outcomes. This study aims to estimate the red blood cell (RBC) and platelet content in extracted AIS clots and explore EIS's relevance to clinically important parameters, including stroke etiology and First Pass Effect (FPE).
A total of 508 clots from 426 MT patients at five stroke centers in France, Japan, Serbia, and Spain (February 2021-2024) were analyzed in the Clotbase International Registry. EIS was performed on retrieved clots, followed by Martius Scarlet Blue staining and CD42b immunohistochemistry. EIS based models to quantify RBCs and platelets were designed using a development dataset (n=309), validated on a blinded dataset (n=199), and combined in a full dataset (n=508). Components (median interquartile range (IQR)) were quantified, correlating RBC and platelet percentages with impedance and clinical parameters.
Correlations between content as determined by EIS and histology were validated in a blind dataset for RBCs (r=0.7, P<0.0001) and platelets (r=0.5, P<0.0001). Similar correlations were observed in the full dataset. Large-artery atherosclerosis clots had significantly higher RBC (46.0% (25.7-67.7)) and lower platelet content (31.7% (22.4-42.7)) compared with cardioembolic (RBCs: 34.9% (14.0-56.2); platelets: 36.5% (26.7-51.0)) and cryptogenic (RBCs: 31.5% (17.4-63.6); platelets: 37.8% (28.4-50.8)). FPE was associated with significantly higher RBC (40.0% (25.6-55.4) vs non-FPE: 31.2% (6.6-50.2)) and lower platelet content (42.0% (32.0-54.0) vs non-FPE: 47.7% (30.6-65.0)), confirmed by histology.
EIS of RBCs and platelets provide an accurate assessment of clot composition, correlating strongly with histology. EIS holds the potential to deliver clinically relevant information on clot characteristics at the point of care.
血凝块成分在急性缺血性卒中（AIS）的病理生理学中起关键作用，并影响溶栓和机械取栓（MT）等治疗的效果。开发一种基于电化学阻抗谱（EIS）的设备来识别血凝块特征可以改善卒中治疗结果。本研究旨在估计提取的AIS血凝块中的红细胞（RBC）和血小板含量，并探讨EIS与包括卒中病因和首过效应（FPE）在内的临床重要参数的相关性。
在法国、日本、塞尔维亚和西班牙的五个卒中中心（2021年2月至2024年），对426例MT患者的508个血凝块进行了分析，这些血凝块来自Clotbase国际注册中心。对取出的血凝块进行EIS检测，随后进行马休黄猩红蓝染色和CD42b免疫组织化学检测。使用一个开发数据集（n = 309）设计基于EIS的量化RBC和血小板的模型，在一个盲法数据集（n = 199）上进行验证，并合并到一个完整数据集（n = 508）中。对各成分（中位数四分位数间距（IQR））进行量化，将RBC和血小板百分比与阻抗及临床参数相关联。
在一个盲法数据集中，EIS测定的含量与组织学之间的相关性在RBC方面得到验证（r = 0.7，P < 0.0001），在血小板方面也得到验证（r = 0.5，P < 0.0001）。在完整数据集中观察到类似的相关性。与心源性栓塞性（RBC：34.9%（14.0 - 56.2）；血小板：36.5%（26.7 - 51.0））和隐源性（RBC：31.5%（17.4 - 63.6）；血小板：37.8%（28.4 - 50.8））血凝块相比，大动脉粥样硬化性血凝块的RBC含量显著更高（46.0%（25.7 - 67.7）），血小板含量更低。经组织学证实，FPE与显著更高的RBC（40.0%（25.6 - 55.4），而非FPE为：31.2%（6.6 - 50.2））和更低的血小板含量（42.0%（（32.0 - 54.0），而非FPE为：47.7%（30.6 - 65.0））相关。
RBC和血小板的EIS能够准确评估血凝块成分，与组织学密切相关。EIS有潜力在床边提供关于血凝块特征的临床相关信息。
