Fig 1.
Results for RBC dominant clots: (A) time to recanalize in vitro model; (B) relative clot reduction; (C) RBC release; (D) relative clot degradation rate.
The box plots show mean values (square), median (line), interquartile range (box), and minimum and maximum values (whiskers). The time curves show mean values (square or circle) and standard error (whiskers) of clot length at time intervals. N = 8–12. The presence of collateral augmented alteplase-induced recanalization by 25% compared to the model without collateral (A), but induced similar relative clot reduction (B), RBCs release, (C) and clot degradation rate (D). cv stands for collateral vessel.
Fig 2.
Results for fibrin dominant clots: (A) time to recanalize in vitro model; (B) relative clot reduction; (C) RBC release; (D) relative clot degradation rate.
The box plots show mean values (square), median (line), interquartile range (box), and minimum and maximum values (whiskers). The time curves show mean values (square or circle) and standard error (whiskers) of clot length at time intervals. N = 8–13. The presence of collateral augmented alteplase-induced recanalization by 14% compared to the model without collateral (A), but induced similar relative clot reduction (B), RBCs release (C) and nearly the same relative clot degradation rate; asterisk indicates marginally significant difference between the model with and without collateral (60.2±37.5% vs 35.2±24.6%, difference 25.0%, 95% CI 1.1–51.0%), (D). cv stands for collateral vessel.
Fig 3.
Initial RBC dominant clot compaction in the in vitro MCA model without and with collateral with alteplase applied at clinically relevant concentration (1.3 mg L-1).
Clot length relative to baseline (100%) was determined by the image analysis with pictures taken every 5 min for the first 30 min of the experiment. Collateral circulation reduced the clot compaction, documented as significantly bigger clot length (about 5%) in presence of collateral after 5 minutes of the experiment start. Data are presented as mean ± S.E. of mean. N = 6. Asterisk indicates a statistically significant difference between variants at particular time. cv stands for collateral vessel.
Fig 4.
Proposed concept of collaterals action: The collateral circulation lowered the pressure across the clot which resulted in lesser clot compaction and a subsequent easier clot distal displacement.
The clot occludes the MCA and is compacted due to the trans-clot pressure. This pressure is more pronounced in the MCA without collateral. The presence of collateral does not change the thrombolysis rate. The less compacted clot is more prone to the distal displacement, ie. to the faster recanalization in a primary occlusion site.