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Background: The introduction of stent retrievers has made the complete extraction and histological analysis of human thrombi possible, although many studies have evaluated the retrieved thrombus by mechanical thrombectomy to assess its impact on success of acute stroke treatment, the results remain controversial, in this study we attempt to assess the impact of thrombus composition on mechanical recanalization, clinical outcome and stroke etiology. Objective: Study the histopathological composition of thrombi extracted from acute stroke patients through mechanical thrombectomy, and correlate the findings with the causes of stroke, the imaging findings as well as thrombectomy efficacy in terms of the number of recanalization maneuvers, retrieval resistance, and time to achieve successful reperfusion. Patients and Methods: The study was carried out at Ain Shams University hospitals to Patients presented to emergency department with large vessel occlusion and were candidate for mechanical thrombectomy. Participants were selected as sample sizes of 26 according to those meeting the inclusion Criteria for participant: patients with acute ischemic stroke with evidence of middle cerebral artery occlusion or internal carotid artery occlusion confirmed via cerebral angiography, Age ≥ 18 years old, NIHSS ≥ 6, Aspect score ≥ 6, time from onset to groin puncture is Within 24 hours, Patients for whom cerebral thrombus could be retrieved and collected during mechanical thrombectomy for histopathological analysis, and Agreement for written informed consent for participation or their nearest relatives in this study). Results: In our study, Erythrocyte-rich thrombi were present in 16 cases, while fibrin-rich thrombi were present in 5 cases. A cardioembolic etiology was significantly more prevalent among the patients with erythrocyte-rich thrombi than among those with fibrin/platelet and a P- value of<0.001. Puncture to final reperfusion time was significantly highest in cases with RBCrich with P-value of<0.001, and Number of passes needed to achieve reperfusion was significantly highest in cases with RBCrich with P-value 0.002. Conclusion: The current study showed Erythrocyte-rich thrombi were associated with a reduced number of recanalization maneuvers, shorter arrival-to-recanalization time interval, and more favorable clinical outcomes. This study also suggests that the histological composition of retrieved thrombi is significantly different between stroke subtypes. Cardioembolic thrombi have a higher percentage of erythrocytes and fewer fibrin/platelet than do non cardioembolic thrombi. [ABSTRACT FROM AUTHOR]

Background: Mechanical thrombectomy (MT) has become the standard treatment in patients suffering from acute ischemic stroke (AIS) due to large vessel occlusion (LVO). It can be classified into thrombo-aspiration, stent-retrieval, and aspirationretriever combined technique. The evidence on the optimal therapy with acceptable outcomes of safety and efficacy is still limited. Therefore, we conducted this study to compare between stent retriever versus aspiration techniques in MT regarding procedural safety and incidence of complications. Methods: This prospective cohort study was conducted at Ain Shams University Hospitals, Egypt. One hundred patients admitted to stroke unit with anterior circulation AIS who met inclusion criteria for MT were recruited over three years from March 2020 to March 2023. The included patients were divided into two groups: group one included 50 patients treated with stent retriever and group two included 50 patients treated with contact aspiration thrombectomy. Results: The median (IQR) for age was 64 (52.5 - 71.5) years. 53 (53%) were males and 47 (47%) were females. No significant difference was found between the compared techniques regarding procedure time (p-value=0.551), time to recanalization (p-value =0.090), thrombolysis in cerebral infarction score (TICI) (pvalue =0.461. Conclusion: Among patients with ischemic stroke in anterior circulation undergoing MT, contact aspiration and stent retriever were comparable regarding successful recanalization rate. [ABSTRACT FROM AUTHOR]

Background: Acute ischemic stroke (AIS) after percutaneous cardiac catheterization (PCI) is a known complication with incidence reports of ranges between 0.2% and 0.5%. It is associated with an in-hospital mortality rate of 20%, with markedly increased long-term mortality (1). Administration of Intravenous thrombolysis (IVT) is the recommended standard of care in acute ischemic stroke during the first 4.5 hours from stroke onset. However, current guidelines exclude intravenous thrombolysis in heparinized patients with partial thromboplastin time (PTT) greater than 40 seconds (2) Protamine is an efficient antidote known for the anticoagulant effect of heparin, and it can neutralize its effect within 5 minutes (3). Aim of the Work: To assess the safety of IVT after heparin reversal by protamine sulfate in ischemic Stroke patients After PCI. Patient and Method: The total number of patients who developed early IP stroke (within 4.5 hours from the end of PCI) was 42. All of them received loading antiplatelets before PCI. Results: out of 21 patients received IVT after heparin reversal by protamine, no patient had died, 2 cases had non symptomatic intracranial hemorrhage (ICH), with significant improvement in stroke parameters and shorter length of stay Conclusion: IVT following heparin reversal by protamine in appropriately selected AIS patients appears to be safe from a symptomatic ICH standpoint and may be beneficial. Extreme caution is warranted in applying these results to routine clinical practice. Rather, we suggest that thrombolysis may still be considered in AIS patients on therapeutic heparin who are not candidates for MT. [ABSTRACT FROM AUTHOR]