TY - JOUR
T1 - Characterization of the ‘White’ Appearing Clots that Cause Acute Ischemic Stroke
AU - Mereuta, Oana Madalina
AU - Rossi, Rosanna
AU - Douglas, Andrew
AU - Gil, Sara Molina
AU - Fitzgerald, Seán
AU - Pandit, Abhay
AU - McCarthy, Ray
AU - Gilvarry, Michael
AU - Ceder, Eric
AU - Dunker, Dennis
AU - Nordanstig, Annika
AU - Redfors, Petra
AU - Jood, Katarina
AU - Magoufis, Georgios
AU - Psychogios, Klearchos
AU - Tsivgoulis, Georgios
AU - O'Hare, Alan
AU - Power, Sarah
AU - Brennan, Paul
AU - Nagy, András
AU - Vadász, Ágnes
AU - Brinjikji, Waleed
AU - Kallmes, David F.
AU - Szikora, Istvan
AU - Rentzos, Alexandros
AU - Tatlisumak, Turgut
AU - Thornton, John
AU - Doyle, Karen M.
N1 - Publisher Copyright:
© 2021 The Author(s)
PY - 2021/12
Y1 - 2021/12
N2 - Objectives: Most clots retrieved from patients with acute ischemic stroke are ‘red’ in color. ‘White’ clots represent a less common entity and their histological composition is less known. Our aim was to investigate the composition, imaging and procedural characteristics of ‘white’ clots retrieved by mechanical thrombectomy. Materials and methods: Seventy five ‘white’ thrombi were selected by visual inspection from a cohort of 760 clots collected as part of the RESTORE registry. Clots were evaluated histopathologically. Results: Quantification of Martius Scarlett Blue stain identified platelets/other as the major component in ‘white’ clots’ (mean of 55% of clot overall composition) followed by fibrin (31%), red blood cells (6%) and white blood cells (3%). ‘White’ clots contained significantly more platelets/other (p<0.001*) and collagen/calcification (p<0.001*) and less red blood cells (p<0.001*) and white blood cells (p=0.018*) than ‘red’ clots. The mean platelet and von Willebrand Factor expression was 43% and 24%, respectively. Adipocytes were found in four cases. ‘White’ clots were significantly smaller (p=0.016*), less hyperdense (p=0.005*) on computed tomography angiography/non-contrast CT and were associated with a smaller extracted clot area (p<0.001*) than ‘red’ clots. They primarily caused the occlusion of middle cerebral artery, were less likely to be removed by aspiration and more likely to require rescue-therapy for retrieval. Conclusions: ‘White’ clots represented 14% of our cohort and were platelet, von Willebrand Factor and collagen/calcification-rich. ‘White’ clots were smaller, less hyperdense, were associated with significantly more distal occlusions and were less successfully removed by aspiration alone than ‘red’ clots.
AB - Objectives: Most clots retrieved from patients with acute ischemic stroke are ‘red’ in color. ‘White’ clots represent a less common entity and their histological composition is less known. Our aim was to investigate the composition, imaging and procedural characteristics of ‘white’ clots retrieved by mechanical thrombectomy. Materials and methods: Seventy five ‘white’ thrombi were selected by visual inspection from a cohort of 760 clots collected as part of the RESTORE registry. Clots were evaluated histopathologically. Results: Quantification of Martius Scarlett Blue stain identified platelets/other as the major component in ‘white’ clots’ (mean of 55% of clot overall composition) followed by fibrin (31%), red blood cells (6%) and white blood cells (3%). ‘White’ clots contained significantly more platelets/other (p<0.001*) and collagen/calcification (p<0.001*) and less red blood cells (p<0.001*) and white blood cells (p=0.018*) than ‘red’ clots. The mean platelet and von Willebrand Factor expression was 43% and 24%, respectively. Adipocytes were found in four cases. ‘White’ clots were significantly smaller (p=0.016*), less hyperdense (p=0.005*) on computed tomography angiography/non-contrast CT and were associated with a smaller extracted clot area (p<0.001*) than ‘red’ clots. They primarily caused the occlusion of middle cerebral artery, were less likely to be removed by aspiration and more likely to require rescue-therapy for retrieval. Conclusions: ‘White’ clots represented 14% of our cohort and were platelet, von Willebrand Factor and collagen/calcification-rich. ‘White’ clots were smaller, less hyperdense, were associated with significantly more distal occlusions and were less successfully removed by aspiration alone than ‘red’ clots.
KW - Ischemic stroke
KW - Macroscopic appearance
KW - Mechanical thrombectomy
KW - Platelets
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U2 - 10.1016/j.jstrokecerebrovasdis.2021.106127
DO - 10.1016/j.jstrokecerebrovasdis.2021.106127
M3 - Article
C2 - 34592611
AN - SCOPUS:85115909382
SN - 1052-3057
VL - 30
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 12
M1 - 106127
ER -