Periodontitis is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association remain unclear.
Our objective was to determine whether Porphyromonas gingivalis ...(Pg), a periodontal bacterium, could be detected within thrombus aspirates, modify thrombus composition, and endovascular therapy responses.
The presence of Pg gingipain in 175 consecutive thrombi from patients with large vessel occlusion stroke enrolled in the multicenter research cohort compoCLOT was investigated by immunostaining. Thrombus blood cell composition according to gingipain status was analyzed in a subset of 63 patients.
Pg gingipain immunostaining was positive in 33.7% of thrombi (95% CI, 26.7%-40.8%). The percentage of near to complete reperfusion (modified Thrombolysis in Cerebral Infarction Score 2c/3) at the end of the procedure was lower in the Pgpos group than the Pgneg group (39.0% vs 57.8% respectively; adjusted odds ratio, 0.38; 95% CI, 0.19-0.77). At 3 months, 35.7% of patients in the Pgpos group had a favorable neurological outcome vs 49.5% in the Pgneg group (odds ratio, 0.65; 95% CI, 0.30-1.40). Quantitative analysis of a subset of 63 thrombi showed that neutrophil elastase content was significantly (P < .05) higher in Pgpos thrombi than in Pgneg thrombi.
Our results indicate that intrathrombus Pg gingipain is associated with increased neutrophil content and resistance to endovascular therapy.
•Thrombus composition influences the success of endovascular therapy in ischemic stroke.•The impact of periodontitis on endovascular therapy and stroke outcomes is unknown.•This study demonstrated that Porphyromonas gingivalis increases neutrophil content in thrombi.•Porphyromonas gingivalis makes ischemic stroke thrombi more resistant to endovascular therapy.
Nursing care after thrombectomy Boursin, Perrine; Menoud, Claude; De La Roche Souvestre, Marion ...
Soins; la revue de référence infirmière
63, Issue:
828
Journal Article
Peer reviewed
Since its inception in 2015, thrombectomy has revolutionised the emergency management of ischaemic stroke with large vessel occlusion. Indeed, early endovascular extraction of the thrombus ...considerably improves the prognosis. Different medical teams are involved in the critically urgent management of these very fragile patients.
Intravenous thrombolysis is one of two emergency procedures for ischaemic stroke. Its implementation requires fine coordination of the healthcare team and must be adapted to the local context of each ...hospital and sector. International good clinical practice guidelines are available to support team organisation.
Background and purpose:
First pass effect (FPE), the occurrence of complete reperfusion after one pass with no rescue attempt during endovascular therapy (EVT), is associated with the best clinical ...outcome after an acute ischemic stroke (AIS). Previous studies evaluating FPE occurrence according to EVT technical strategies, occlusion locations, or thrombus composition have provided controversial results. Here, we performed a correlation analysis between FPE occurrence and AIS thrombus cellular composition, as assessed using quantitative biochemical assays.
Patients and methods:
Homogenates of AIS thrombi from 250 patients were prepared by mechanical grinding. Platelet, red blood cell (RBC), and leukocyte contents of AIS thrombi were respectively estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. FPE was defined as a modified Thrombolysis in Cerebral Infraction (mTICI) score of 2C or 3 after a single EVT device pass.
Results:
AIS thrombi successfully removed after a single pass were poorer in GPVI (0.098 ± 0.023 vs 0.111 ± 0.024 ng/mg, p < 0.001) compared to those whose removal had required several passes. GPVI content was also significantly associated with a higher number of device passes and a longer procedure time. No such significant correlation was found with DNA and heme content.
Discussion and conclusion:
Thrombus platelet content may hamper thrombus removal by EVT. This result suggests that adjunctive therapies or functionalization of retrieval devices targeting platelets may improve EVT efficacy.
