TY - JOUR
T1 - Association between clot composition and stroke origin in mechanical thrombectomy patients
T2 - Analysis of the Stroke Thromboembolism Registry of Imaging and Pathology
AU - Brinjikji, Waleed
AU - Nogueira, Raul G.
AU - Kvamme, Peter
AU - Layton, Kennith F.
AU - Almandoz, Josser E.Delgado
AU - Hanel, Ricardo A.
AU - Pereira, Vitor Mendes
AU - Almekhlafi, Mohammed A.
AU - Yoo, Albert J.
AU - Jahromi, Babak S.
AU - Gounis, Matthew J.
AU - Patel, Biraj
AU - Abbasi, Mehdi
AU - Fitzgerald, Seán
AU - Mereuta, Oana Madalina
AU - Dai, Daying
AU - Kadirvel, Ramanathan
AU - Doyle, Karen
AU - Savastano, Luis
AU - Cloft, Harry J.
AU - Haussen, Diogo C.
AU - Al-Bayati, Alhamza R.
AU - Mohammaden, Mahmoud H.
AU - Pisani, Leonardo
AU - Rodrigues, Gabriel Martins
AU - Thacker, Ike C.
AU - Kayan, Yasha
AU - Copelan, Alexander
AU - Aghaebrahim, Amin
AU - Sauvageau, Eric
AU - Demchuk, Andrew M.
AU - Bhuva, Parita
AU - Soomro, Jazba
AU - Nazari, Pouya
AU - Cantrell, Donald Robert
AU - Puri, Ajit S.
AU - Entwistle, John
AU - Polley, Eric C.
AU - Kallmes, David F.
N1 - Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Background We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients to study the association between histological composition and stroke etiology Methods Consecutive patients enrolled in the Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) were included in this study. All patients underwent mechanical thrombectomy and retrieved clots were sent to a central core lab for processing. Histological analysis was performed using martius scarlet blue (MSB) staining, and quantification for red blood cells (RBCs), white blood cells (WBCs), fibrin and platelets was performed using Orbit Image Software. A Wilcoxon test was used for continuous variables and χ 2 test for categorical variables. Results 1350 patients were included in this study. The overall rate of Thrombolysis In Cerebral Infarction (TICI) 2c/3 was 68%. 501 patients received tissue plasminogen activator (tPA) (37%). 267 patients (20%) had a large artery atherosclerosis (LAA) source, 662 (49%) a cardioembolic (CE) source, 301 (22%) were cryptogenic, and the remainder had other identifiable sources including hypercoagulable state or dissection. LAA thrombi had a higher mean RBC density (46±23% vs 42±22%, p=0.01) and a lower platelet density (24±18% vs 27±18%, p=0.03) than CE thrombi. Clots from dissection patients had the highest mean RBC density (50±24%) while clots from patients with a hypercoagulable state had the lowest mean RBC density (26±21%). Conclusions Our study found statistically significant but clinically insignificant differences between clots of CE and LAA etiologies. Future studies should emphasize molecular, proteomic and immunohistochemical characteristics to determine links between clot composition and etiology.
AB - Background We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients to study the association between histological composition and stroke etiology Methods Consecutive patients enrolled in the Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) were included in this study. All patients underwent mechanical thrombectomy and retrieved clots were sent to a central core lab for processing. Histological analysis was performed using martius scarlet blue (MSB) staining, and quantification for red blood cells (RBCs), white blood cells (WBCs), fibrin and platelets was performed using Orbit Image Software. A Wilcoxon test was used for continuous variables and χ 2 test for categorical variables. Results 1350 patients were included in this study. The overall rate of Thrombolysis In Cerebral Infarction (TICI) 2c/3 was 68%. 501 patients received tissue plasminogen activator (tPA) (37%). 267 patients (20%) had a large artery atherosclerosis (LAA) source, 662 (49%) a cardioembolic (CE) source, 301 (22%) were cryptogenic, and the remainder had other identifiable sources including hypercoagulable state or dissection. LAA thrombi had a higher mean RBC density (46±23% vs 42±22%, p=0.01) and a lower platelet density (24±18% vs 27±18%, p=0.03) than CE thrombi. Clots from dissection patients had the highest mean RBC density (50±24%) while clots from patients with a hypercoagulable state had the lowest mean RBC density (26±21%). Conclusions Our study found statistically significant but clinically insignificant differences between clots of CE and LAA etiologies. Future studies should emphasize molecular, proteomic and immunohistochemical characteristics to determine links between clot composition and etiology.
KW - stroke
KW - thrombectomy
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U2 - 10.1136/neurintsurg-2020-017167
DO - 10.1136/neurintsurg-2020-017167
M3 - Article
C2 - 33722963
AN - SCOPUS:85102591282
SN - 1759-8478
VL - 13
SP - 594
EP - 598
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 7
ER -