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@ARTICLE{KarimianJazi:277903,
      author       = {K. Karimian-Jazi and D. F. Vollherbst and D. Schwarz and M.
                      Fischer and K. Schregel and G. Bauer and A. Kocharyan and V.
                      Sturm and U. Neuberger and J. Jesser and C. Herweh and C.
                      Ulfert and T. Hilgenfeld and F. Seker and F. Preisner and N.
                      Schmitt and T. Charlet and S. Hamelmann$^*$ and F. Sahm$^*$
                      and S. Heiland and W. Wick$^*$ and P. A. Ringleb and L.
                      Schirmer and M. Bendszus and M. A. Möhlenbruch and M. O.
                      Breckwoldt},
      title        = {{MR} microscopy to assess clot composition following
                      mechanical thrombectomy predicts recanalization and clinical
                      outcome.},
      journal      = {Journal of neuroInterventional surgery},
      volume       = {16},
      number       = {8},
      issn         = {1759-8478},
      address      = {London},
      publisher    = {BMJ Journals},
      reportid     = {DKFZ-2023-01563},
      pages        = {830-837},
      year         = {2024},
      note         = {2024 Jul 16;16(8):830-837},
      abstract     = {Mechanical thrombectomy (MT) is the standard of care for
                      patients with a stroke and large vessel occlusion. Clot
                      composition is not routinely assessed in clinical practice
                      as no specific diagnostic value is attributed to it, and MT
                      is performed in a standardized 'non-personalized' approach.
                      Whether different clot compositions are associated with
                      intrinsic likelihoods of recanalization success or treatment
                      outcome is unknown.We performed a prospective,
                      non-randomized, single-center study and analyzed the clot
                      composition in 60 consecutive patients with ischemic stroke
                      undergoing MT. Clots were assessed by ex vivo
                      multiparametric MRI at 9.4 T (MR microscopy), cone beam CT,
                      and histopathology. Clot imaging was correlated with
                      preinterventional CT and clinical data.MR microscopy showed
                      red blood cell (RBC)-rich $(21.7\%),$ platelet-rich
                      $(white,38.3\%)$ or mixed clots $(40.0\%)$ as distinct
                      morphological entities, and MR microscopy had high accuracy
                      of $95.4\%$ to differentiate clots. Clot composition could
                      be further stratified on preinterventional non-contrast head
                      CT by quantification of the hyperdense artery sign. During
                      MT, white clots required more passes to achieve final
                      recanalization and were not amenable to contact aspiration
                      compared with mixed and RBC-rich clots (maneuvers: 4.7 vs
                      3.1 and 1.2 passes, P<0.05 and P<0.001, respectively),
                      whereas RBC-rich clots showed higher probability of first
                      pass recanalization $(76.9\%)$ compared with white clots
                      $(17.4\%).$ White clots were associated with poorer clinical
                      outcome at discharge and 90 days after MT.Our study
                      introduces MR microscopy to show that the hyperdense artery
                      sign or MR relaxometry could guide interventional strategy.
                      This could enable a personalized treatment approach to
                      improve outcome of patients undergoing MT.},
      keywords     = {Stroke (Other) / Thrombectomy (Other)},
      cin          = {B300 / HD01 / B320},
      ddc          = {610},
      cid          = {I:(DE-He78)B300-20160331 / I:(DE-He78)HD01-20160331 /
                      I:(DE-He78)B320-20160331},
      pnm          = {312 - Funktionelle und strukturelle Genomforschung
                      (POF4-312)},
      pid          = {G:(DE-HGF)POF4-312},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37527928},
      doi          = {10.1136/jnis-2023-020594},
      url          = {https://inrepo02.dkfz.de/record/277903},
}