Platelet-Rich Emboli in Cerebral Large Vessel Occlusion Are Associated With a Large Artery Atherosclerosis Source

Seán Fitzgerald, Daying Dai, Shunli Wang, Andrew Douglas, Ramanathan Kadirvel, Kennith F. Layton, Ike C. Thacker, Matthew J. Gounis, Ju Yu Chueh, Ajit S. Puri, Mohammed Almekhlafi, Andrew M. Demchuk, Ricardo A. Hanel, Eric Sauvageau, Amin Aghaebrahim, Albert J. Yoo, Peter Kvamme, Vitor M Pereira, Yasha Kayan, Josser E. Delgado AlmandozRaul G. Nogueira, Alejandro A. Rabinstein, David F. Kallmes, Karen M. Doyle, Waleed Brinjikji

Research output: Contribution to journalArticle

Abstract

Background and Purpose- Nearly 30% of large vessel occlusion acute ischemic stroke clots are from an unknown source. We assessed histological clot composition in a series of patients with large vessel occlusion and investigated correlations between clot composition and stroke pathogenesis. Methods- As part of the multi-institutional STRIP registry (Stroke Thromboembolism Registry of Imaging and Pathology), consecutive emboli retrieved during mechanical thrombectomy were stained using Martius Scarlett Blue and analyzed using machine learning software. We assessed proportions of red blood cells, fibrin, platelets, and white blood cells. Correlations between clot components and stroke pathogenesis (large artery atherosclerosis, cardioembolism, and stroke of undetermined pathogenesis) were assessed using SPSS22. Results- One hundred five patients were included. The proportion of platelet-rich clots (55.0% versus 21.2%; P=0.005) and percentage of platelet content (22.1±4.2% versus 13.9±14.2%; P=0.03) was significantly higher in the large artery atherosclerosis group compared with the cardioembolic group. The proportion of platelet-rich clots (50.0% versus 21.2%; P=0.024) was also significantly higher in the cryptogenic group compared with cardioembolic cases. Large artery atherosclerosis and cryptogenic cases had a similar proportion of platelet-rich clots (55.0% versus 50.0%; P=0.636). There was no significant difference between stroke pathogenesis and the other major clot components. Conclusions- High platelet content of emboli is associated with a large artery atherosclerosis etiology of large vessel occlusion.

Original languageEnglish (US)
Pages (from-to)1907-1910
Number of pages4
JournalStroke
Volume50
Issue number7
DOIs
StatePublished - Jul 1 2019

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Intracranial Embolism
Atherosclerosis
Blood Platelets
Arteries
Stroke
Embolism
Registries
Thrombectomy
Thromboembolism
Fibrin
Leukocytes
Software
Erythrocytes
Pathology

Keywords

  • arteries
  • blood platelets
  • fibrin
  • humans
  • software

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Platelet-Rich Emboli in Cerebral Large Vessel Occlusion Are Associated With a Large Artery Atherosclerosis Source. / Fitzgerald, Seán; Dai, Daying; Wang, Shunli; Douglas, Andrew; Kadirvel, Ramanathan; Layton, Kennith F.; Thacker, Ike C.; Gounis, Matthew J.; Chueh, Ju Yu; Puri, Ajit S.; Almekhlafi, Mohammed; Demchuk, Andrew M.; Hanel, Ricardo A.; Sauvageau, Eric; Aghaebrahim, Amin; Yoo, Albert J.; Kvamme, Peter; M Pereira, Vitor; Kayan, Yasha; Delgado Almandoz, Josser E.; Nogueira, Raul G.; Rabinstein, Alejandro A.; Kallmes, David F.; Doyle, Karen M.; Brinjikji, Waleed.

In: Stroke, Vol. 50, No. 7, 01.07.2019, p. 1907-1910.

Research output: Contribution to journalArticle

Fitzgerald, S, Dai, D, Wang, S, Douglas, A, Kadirvel, R, Layton, KF, Thacker, IC, Gounis, MJ, Chueh, JY, Puri, AS, Almekhlafi, M, Demchuk, AM, Hanel, RA, Sauvageau, E, Aghaebrahim, A, Yoo, AJ, Kvamme, P, M Pereira, V, Kayan, Y, Delgado Almandoz, JE, Nogueira, RG, Rabinstein, AA, Kallmes, DF, Doyle, KM & Brinjikji, W 2019, 'Platelet-Rich Emboli in Cerebral Large Vessel Occlusion Are Associated With a Large Artery Atherosclerosis Source', Stroke, vol. 50, no. 7, pp. 1907-1910. https://doi.org/10.1161/STROKEAHA.118.024543
Fitzgerald, Seán ; Dai, Daying ; Wang, Shunli ; Douglas, Andrew ; Kadirvel, Ramanathan ; Layton, Kennith F. ; Thacker, Ike C. ; Gounis, Matthew J. ; Chueh, Ju Yu ; Puri, Ajit S. ; Almekhlafi, Mohammed ; Demchuk, Andrew M. ; Hanel, Ricardo A. ; Sauvageau, Eric ; Aghaebrahim, Amin ; Yoo, Albert J. ; Kvamme, Peter ; M Pereira, Vitor ; Kayan, Yasha ; Delgado Almandoz, Josser E. ; Nogueira, Raul G. ; Rabinstein, Alejandro A. ; Kallmes, David F. ; Doyle, Karen M. ; Brinjikji, Waleed. / Platelet-Rich Emboli in Cerebral Large Vessel Occlusion Are Associated With a Large Artery Atherosclerosis Source. In: Stroke. 2019 ; Vol. 50, No. 7. pp. 1907-1910.
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T1 - Platelet-Rich Emboli in Cerebral Large Vessel Occlusion Are Associated With a Large Artery Atherosclerosis Source

AU - Fitzgerald, Seán

AU - Dai, Daying

AU - Wang, Shunli

AU - Douglas, Andrew

AU - Kadirvel, Ramanathan

AU - Layton, Kennith F.

AU - Thacker, Ike C.

AU - Gounis, Matthew J.

AU - Chueh, Ju Yu

AU - Puri, Ajit S.

AU - Almekhlafi, Mohammed

AU - Demchuk, Andrew M.

AU - Hanel, Ricardo A.

AU - Sauvageau, Eric

AU - Aghaebrahim, Amin

AU - Yoo, Albert J.

AU - Kvamme, Peter

AU - M Pereira, Vitor

AU - Kayan, Yasha

AU - Delgado Almandoz, Josser E.

AU - Nogueira, Raul G.

AU - Rabinstein, Alejandro A.

AU - Kallmes, David F.

AU - Doyle, Karen M.

AU - Brinjikji, Waleed

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background and Purpose- Nearly 30% of large vessel occlusion acute ischemic stroke clots are from an unknown source. We assessed histological clot composition in a series of patients with large vessel occlusion and investigated correlations between clot composition and stroke pathogenesis. Methods- As part of the multi-institutional STRIP registry (Stroke Thromboembolism Registry of Imaging and Pathology), consecutive emboli retrieved during mechanical thrombectomy were stained using Martius Scarlett Blue and analyzed using machine learning software. We assessed proportions of red blood cells, fibrin, platelets, and white blood cells. Correlations between clot components and stroke pathogenesis (large artery atherosclerosis, cardioembolism, and stroke of undetermined pathogenesis) were assessed using SPSS22. Results- One hundred five patients were included. The proportion of platelet-rich clots (55.0% versus 21.2%; P=0.005) and percentage of platelet content (22.1±4.2% versus 13.9±14.2%; P=0.03) was significantly higher in the large artery atherosclerosis group compared with the cardioembolic group. The proportion of platelet-rich clots (50.0% versus 21.2%; P=0.024) was also significantly higher in the cryptogenic group compared with cardioembolic cases. Large artery atherosclerosis and cryptogenic cases had a similar proportion of platelet-rich clots (55.0% versus 50.0%; P=0.636). There was no significant difference between stroke pathogenesis and the other major clot components. Conclusions- High platelet content of emboli is associated with a large artery atherosclerosis etiology of large vessel occlusion.

AB - Background and Purpose- Nearly 30% of large vessel occlusion acute ischemic stroke clots are from an unknown source. We assessed histological clot composition in a series of patients with large vessel occlusion and investigated correlations between clot composition and stroke pathogenesis. Methods- As part of the multi-institutional STRIP registry (Stroke Thromboembolism Registry of Imaging and Pathology), consecutive emboli retrieved during mechanical thrombectomy were stained using Martius Scarlett Blue and analyzed using machine learning software. We assessed proportions of red blood cells, fibrin, platelets, and white blood cells. Correlations between clot components and stroke pathogenesis (large artery atherosclerosis, cardioembolism, and stroke of undetermined pathogenesis) were assessed using SPSS22. Results- One hundred five patients were included. The proportion of platelet-rich clots (55.0% versus 21.2%; P=0.005) and percentage of platelet content (22.1±4.2% versus 13.9±14.2%; P=0.03) was significantly higher in the large artery atherosclerosis group compared with the cardioembolic group. The proportion of platelet-rich clots (50.0% versus 21.2%; P=0.024) was also significantly higher in the cryptogenic group compared with cardioembolic cases. Large artery atherosclerosis and cryptogenic cases had a similar proportion of platelet-rich clots (55.0% versus 50.0%; P=0.636). There was no significant difference between stroke pathogenesis and the other major clot components. Conclusions- High platelet content of emboli is associated with a large artery atherosclerosis etiology of large vessel occlusion.

KW - arteries

KW - blood platelets

KW - fibrin

KW - humans

KW - software

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