Unraveling the Enigma: Correlating Thrombus Histopathology With the Number of Passes in Mechanical Thrombectomy.

Background Mechanical thrombectomy has revolutionized the treatment of acute ischemic stroke. Although a few studies have explored the correlation between thrombus histopathology and the number of passes required, the relationship remains unclear. The composition of the thrombus significantly influences the complexity of the procedure. Research has shown that erythrocyte-rich clots are associated with better reperfusion outcomes and fewer passes, whereas fibrin-rich clots are more challenging to retrieve and yield poorer outcomes. This study aims to investigate the association between thrombus histopathology and the number of passes during mechanical thrombectomy. Methods This retrospective observational study included 60 patients undergoing mechanical thrombectomy. Thrombus samples were analyzed histologically using hematoxylin-eosin staining and classified as either erythrocyte-rich (>50% erythrocytes) or fibrin-rich (>50% fibrin). The number of thrombectomy passes and patient demographics were recorded. Statistical analysis was performed to identify associations. Results RBC-rich thrombi were associated with fewer passes (p=0.035). Additionally, patients aged 45-65 years had a higher proportion of fibrin-rich clots, which required more passes (p=0.021). Conclusion This study demonstrates a significant association between thrombus histopathology and the number of passes during mechanical thrombectomy. Understanding thrombus composition may aid in tailoring therapeutic approaches and improving patient outcomes. Overall, thrombus composition was significantly correlated with the number of passes, with erythrocyte-rich thrombi requiring fewer attempts for successful retrieval.