{
  "abstract": "Background Clot composition plays a key role in the pathophysiology of Acute Ischemic Stroke (AIS) and impacts the effectiveness of treatments such as thrombolysis and mechanical thrombectomy (MT). Developing an electrochemical impedance spectroscopy (EIS) based device to identify clot characteristics could improve stroke treatment outcomes. This study aims to estimate the red blood cell (RBC) and platelet content in extracted AIS clots and explore EIS’s relevance to clinically important parameters, including stroke etiology and First Pass Effect (FPE).Methods A total of 508 clots from 426 MT patients at five stroke centers in France, Japan, Serbia, and Spain (February 2021–2024) were analyzed in the Clotbase International Registry. EIS was performed on retrieved clots, followed by Martius Scarlet Blue staining and CD42b immunohistochemistry. EIS based models to quantify RBCs and platelets were designed using a development dataset (n=309), validated on a blinded dataset (n=199), and combined in a full dataset (n=508). Components (median interquartile range (IQR)) were quantified, correlating RBC and platelet percentages with impedance and clinical parameters.Results Correlations between content as determined by EIS and histology were validated in a blind dataset for RBCs (r=0.7, P<0.0001) and platelets (r=0.5, P<0.0001). Similar correlations were observed in the full dataset. Large-artery atherosclerosis clots had significantly higher RBC (46.0% (25.7–67.7)) and lower platelet content (31.7% (22.4–42.7)) compared with cardioembolic (RBCs: 34.9% (14.0–56.2); platelets: 36.5% (26.7–51.0)) and cryptogenic (RBCs: 31.5% (17.4–63.6); platelets: 37.8% (28.4–50.8)). FPE was associated with significantly higher RBC (40.0% (25.6–55.4) vs non-FPE: 31.2% (6.6–50.2)) and lower platelet content (42.0% (32.0–54.0) vs non-FPE: 47.7% (30.6–65.0)), confirmed by histology.Conclusion EIS of RBCs and platelets provide an accurate assessment of clot composition, correlating strongly with histology. EIS holds the potential to deliver clinically relevant information on clot characteristics at the point of care.",
  "authors": [
    {
      "affiliations": [
        "CÚRAM Research Ireland Centre for Medical Devices, University of Galway, Galway, County Galway, Ireland",
        "Department of Physiology, University of Galway, Galway, County Galway, Ireland"
      ],
      "name": "Cansu Sahin"
    },
    {
      "affiliations": [
        "Sensome SAS, Massy, France"
      ],
      "name": "Alice Giraud"
    },
    {
      "affiliations": [
        "CÚRAM Research Ireland Centre for Medical Devices, University of Galway, Galway, County Galway, Ireland",
        "Department of Physiology, University of Galway, Galway, County Galway, Ireland"
      ],
      "name": "Nazan Güner Sak"
    },
    {
      "affiliations": [
        "Department of Physiology, University of Galway, Galway, County Galway, Ireland"
      ],
      "name": "Wenyi Liu"
    },
    {
      "affiliations": [
        "Sensome SAS, Massy, France"
      ],
      "name": "Pierluca Messina"
    },
    {
      "affiliations": [
        "Sensome SAS, Massy, France"
      ],
      "name": "Franz Bozsak"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Therapeutic Neuroradiology, CHU de Toulouse Pôle neurosciences, Toulouse, France",
        "Radiology Department, Ramsay Santé Clinique des Cèdres, Cornebarrieu, France"
      ],
      "name": "Jean Darcourt"
    },
    {
      "affiliations": [
        "Neuroradiology, CHU Toulouse, Toulouse, Occitanie, France"
      ],
      "name": "Federico Sacchetti"
    },
    {
      "affiliations": [
        "Neuroradiology, University Hospital of Purpan, Toulouse, France"
      ],
      "name": "Anne-Christine Januel"
    },
    {
      "affiliations": [
        "Toulouse 2 University, Toulouse, Occitanie, France"
      ],
      "name": "Guillaume Bellanger"
    },
    {
      "affiliations": [
        "Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France"
      ],
      "name": "Jorge Pagola"
    },
    {
      "affiliations": [
        "Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Spain"
      ],
      "name": "Jesus Juega"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology, Hospital Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Hirotoshi Imamura"
    },
    {
      "affiliations": [
        "Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain"
      ],
      "name": "Tsuyoshi Ohta"
    },
    {
      "affiliations": [
        "Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France"
      ],
      "name": "Laurent Spelle"
    },
    {
      "affiliations": [
        "Department of Physiology, University of Galway, Galway, Ireland"
      ],
      "name": "Vanessa Chalumeau"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology, Hospital Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Uros Mircic"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology, Hospital Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Predrag D Stanarcevic"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France",
        "Department of Neuroradiology, Klinicki centar Srbije, Beograd, Serbia"
      ],
      "name": "Ivan Vukasinovic"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology, Hospital Vall d’Hebron, Barcelona, Spain",
        "Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain"
      ],
      "name": "Marc Ribo"
    },
    {
      "affiliations": [
        "Neurosurgery, Kobe City Medical Center General Hospital, Kobe-city, Hyogo, Japan"
      ],
      "name": "Nobuyuki Sakai"
    },
    {
      "affiliations": [
        "Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France"
      ],
      "name": "Christophe Cognard"
    },
    {
      "affiliations": [
        "CÚRAM Research Ireland Centre for Medical Devices, University of Galway, Galway, County Galway, Ireland",
        "Department of Physiology, University of Galway, Galway, Ireland"
      ],
      "name": "Karen Doyle"
    }
  ],
  "title": "Electrical impedance spectroscopy signatures of red blood cells and platelets in acute ischemic stroke clots in the Clotbase International Registry: Significance for etiology and first pass effect",
  "uid": "eca3874b-78db-5782-a42b-a1035994547d"
}