Removing embolus is like passing toll stations on a highway
“Removing embolus is like passing toll stations on a highway. You passed one, and the next is waiting. If you are stopped at one of them, the journey will be hard to finish.”
At the “Stroke Prevention and Treatment” special of the 8th U.S.-China Health Summit, Zhu Liangfu talked about their preliminary study on thrombus burden and thrombus properties and their experiences in dealing with them in Henan Provincial People’s Hospital.
ZHU Liangfu, Chief Physician, Department of Neurology, Henan Provincial People's Hospital, Deputy Director of the National Center for Advanced Stroke, Henan Provincial Cerebrovascular Hospital, Green Channel Leader, Deputy Director of Henan Interventional Therapy Center
"Thrombosis Load, Nature and Intravascular Recanalization"
String-like Thrombus and Thrombus Cluster are the Most Dangerous in Thrombectomy
“What affect thrombectomy in ischemic stroke? Thrombus burden and thrombus properties are influencing factors.”
According to Zhu, thrombus with its length within a certain range will put little impact on the thrombectomy and prognosis. Otherwise, difficulty of the operation will greatly increase, and the prognosis of patients will be affected as well. In addition, the formation of blood clots also affects unclogging blood vessels. Vessel curvature, bifurcations and thrombus branching may make thrombectomy more difficult.
“String-like thrombus and thrombus cluster are also what we don’t want to see.” said Zhu, “String-like thrombus means not only larger thrombus burden but also more blockages in vessels. Thus, surgery times will be prolonged.”
Zhu pointed out, “While doing blood vessels opening, many factors including location of patients’ blockages, thrombosis, causes of the disease, comorbidities, lesions, devices to be used and expected costs must be taken into consideration. Currently, in order to unclog patients’ blood vessels in a quicker way, our focus is on the direction to which a blood clot flow.”
Thrombus Components and Properties Become Research Hotspots
Zhu pointed out that how thrombus components and properties affect artery opening is a current research hotspot. As early as 2005, study on the connection between age of patients in whom coronary artery thrombosis was detected and artery opening has started, but there are few findings yet. ZHU analyzed that probably what we got are not entire thrombus, so we haven’t got ideal research results.
In addition, thanks to the advancement of the thrombectomy devices and the technique, thrombus density has little effect on artery opening to a certain extent. “But calcified thrombus, if even harder than bones, will make artery opening more than difficult, and the overall mortality rate is as high as 62.5%. Fortunately, the incidence rate of such calcified thrombosis is only 1.3%.” said Zhu Liangfu.
Zhu concluded that if blood clots are soft, or semi-fluid and relatively fresh, it means the red blood cell count is high. Under such circumstances, we’d better to be quick and finish artery opening as soon as possible. But if blood clots formed a long time ago and have come hard and solid, the red blood cell count will be low, but the white blood cell count is relatively high. Then we emphasize the safety of the surgery and usually various devices and technologies will be used in the operation.