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Histopathological and Bacteriological Analysis of Thrombus Material Extracted During Mechanical Thrombectomy in Acute Stroke Patients

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Abstract

Purpose

Management of stroke secondary to septic emboli (SE) remains challenging, due to both the lack of specific recommendations and the gravity of the underlying pathology.The aim of this study is to describe the presence of SE in a series of mechanical thrombectomies (MT), analyzing technical complexity and outcomes with respect to the patients by means of histological analysis and microbiological study of the clot.

Methods

All the retrieved clots were studied under an established protocol, including histopathological and bacteriological study with hematoxylin–eosin, Gram and Gomori trichrome staining.Technical complexity in SE with respect to the series was evaluated by analyzing time of the procedures, number of passes and use of intracranial definitive stents.

Results

Over a 24-month period, bacteria were detected in the retrieved clot of four out of 65 patients (incidence 6.2%). Two cases were eventually diagnosed with infective endocarditis, while the remaining two were diagnosed with urinary tract infection and respiratory septicemia, respectively. Three of the four patients (75%) required an intracranial definitive stent in order to achieve successful recanalization.These procedures were significantly longer (137.7 vs. 59.8 min, p < 0.001), needed a higher number of passes (5.8 vs. 2.2, p < 0.001), and delivery of an intracranial stent more frequently (75% vs. 1.6%, p = 0.008), with respect to the rest of the series.

Conclusions

In our series, systematic histopathological and bacteriological study of the MT samples allowed a higher proportion of SE diagnosis in comparison with previous reports.

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Authors and Affiliations

  1. Neurology Department, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain

    Francisco Hernández-Fernández, Laura Rojas-Bartolomé, Jorge García-García, Óscar Ayo-Martín & Tomás Segura

  2. Radiology Department, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain

    Juan David Molina-Nuevo, Enrique Juliá-Molla & María José Pedrosa-Jiménez

  3. Neuropatology-Surgical Pathology Departement, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain

    Rosa Angélica Barbella-Aponte

  4. Research Unit, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain

    Gemma Serrano-Heras

Authors
  1. Francisco Hernández-Fernández
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  2. Laura Rojas-Bartolomé
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  4. Óscar Ayo-Martín
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  5. Juan David Molina-Nuevo
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  6. Rosa Angélica Barbella-Aponte
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  7. Gemma Serrano-Heras
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  8. Enrique Juliá-Molla
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  9. María José Pedrosa-Jiménez
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  10. Tomás Segura
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Corresponding author

Correspondence to Francisco Hernández-Fernández.

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Ethical Standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hernández-Fernández, F., Rojas-Bartolomé, L., García-García, J. et al. Histopathological and Bacteriological Analysis of Thrombus Material Extracted During Mechanical Thrombectomy in Acute Stroke Patients. Cardiovasc Intervent Radiol 40, 1851–1860 (2017). https://doi.org/10.1007/s00270-017-1718-x

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  • DOI: https://doi.org/10.1007/s00270-017-1718-x

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