Evidence map›Paper›PMID 31541014›Full record

ArticleNeurology2019

Acute ischemic stroke thrombi have an outer shell that impairs fibrinolysis.

Lucas Di Meglio, Jean-Philippe Desilles, Véronique Ollivier, Mialitiana Solo Nomenjanahary, Sara Di Meglio, Catherine Deschildre, Stéphane Loyau, Jean-Marc Olivot, Raphaël Blanc, Michel Piotin and 5 more

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In one paragraph

Article in Neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 82 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Shell Versus Core Architecture and Biology of Thrombi in Acute Ischemic Stroke: A Systematic Review.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Pooled it
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  11. Plg-RMolecular medicine (Cambridge, Mass.) · 2026
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  13. Toward improved thrombolysis in ischemic stroke: targeting nonfibrin components.Research and practice in thrombosis and haemostasis · 2026
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22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors.

Lucas Di MeglioFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.ORCID 0000-0002-5158-8612
Jean-Philippe DesillesFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Véronique OllivierFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Mialitiana Solo NomenjanaharyFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Sara Di MeglioFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Catherine DeschildreFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Stéphane LoyauFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Jean-Marc OlivotFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Raphaël BlancFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.ORCID 0000-0002-3975-3865
Michel PiotinFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.ORCID 0000-0002-1354-4328
Marie-Christine BoutonFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Jean-Baptiste MichelFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Martine Jandrot-PerrusFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
Benoît Ho-Tin-NoéFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France. benoit.ho-tin-noe@inserm.fr.
Mikael MazighiFrom U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThrombi responsible for large vessel occlusion (LVO) in the setting of acute ischemic stroke (AIS) are characterized by a low recanalization rate after IV thrombolysis. To test whether AIS thrombi have inherent common features that limit their susceptibility to thrombolysis, we analyzed the composition and ultrastructural organization of AIS thrombi causing LVO.

methodsA total of 199 endovascular thrombectomy-retrieved thrombi were analyzed by immunohistology and scanning electron microscopy (SEM) and subjected to ex vivo thrombolysis assay. The relationship between thrombus organization and thrombolysis resistance was further investigated in vitro using thrombus produced by recalcification of citrated whole blood.

resultsSEM and immunohistology analyses revealed that, although AIS thrombus composition and organization was highly heterogeneous, AIS thrombi shared a common remarkable structural feature in the form of an outer shell made of densely compacted thrombus components including fibrin, von Willebrand factor, and aggregated platelets. In vitro thrombosis experiments using human blood indicated that platelets were essential to the formation of the thrombus outer shell. Finally, in both AIS and in vitro thrombi

interpretationIrrespective of their etiology and despite their heterogeneity, intracranial thrombi causing LVO have a core shell structure that influences their susceptibility to thrombolysis.

Indexed as

Drug ResistanceThrombectomyAgedAged, 80 and overBlood PlateletsBrain IschemiaErythrocytesExtracellular TrapsFemaleFibrinFibrinolytic AgentsHumansImmunohistochemistryIntracranial ThrombosisIn Vitro TechniquesLeukocytesFibrinFibrinolytic AgentsTissue Plasminogen Activatorvon Willebrand Factor

Identifiers

PMID31541014
PMCPMC6946479

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