Clot characteristics in mechanical thrombectomy: Interim analysis of the excellent registry

Introduction: Red blood cell (RBC) rich vs fibrin rich clots have different mechanical properties and greater knowledge about clot composition in the context of clinical, imaging, and procedural factors in mechanical thrombectomy (MT) may help with procedural optimization The EXCELLENT Registry (NCT03685578) is a prospective, global, multi-center, observational registry of EmboTrap as the first line MT device for large vessel occlusion (LVO) We present an interim analysis of clot collected per pass in the registry Methods: Five hundred thirty-three clot specimens from 376 subjects were collected by 20 sites and sent for analysis by independent Central Labs under standardized protocol Analysis was interrupted by COVID-19, but the labs were fully operational as of June 2020 and on track to deliver results for 300 subjects in Q4 At the time of abstract submission, composition data for 234 clots from 163 subjects was available All available data will be presented at the time of the conference Results: Cardioembolic etiology (n=100) was associated with lower RBC (40 2 vs 47 2%) and higher fibrin content (31 7 vs 26 7%) compared to large artery disease (n=12) Hyperdense/vessel susceptibility sign (78+, 24-, per independent imaging core lab) corresponded to higher mean RBC content (44 4 vs 34 9%) Treatment with IV tPA (60+, 91-) had no clear impact on clot composition (42 3 vs 40 6% RBC;30 4 vs 30 0% fibrin) Notably, clots retrieved with the first 2 passes of were more RBC rich (42 1 vs 28 0%) and clots retrieved in higher passes had a higher average fibrin content (35 5 vs 29 6%) suggesting that higher fibrin content leads to greater refractoriness Conclusions: Clot density/susceptibility on baseline imaging, stroke etiology and number ofthrombectomy passes were associated with differential clot composition These findings may havepotential implications for the development of better MT strategies