@article{ff1b891abdb74089acc181181a64d7d5,
title = "Platelet-Rich Emboli in Cerebral Large Vessel Occlusion Are Associated with a Large Artery Atherosclerosis Source",
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.",
keywords = "arteries, blood platelets, fibrin, humans, software",
author = "Se{\'a}n Fitzgerald and Daying Dai and Shunli Wang and Andrew Douglas and Ramanathan Kadirvel and Layton, {Kennith F.} and Thacker, {Ike C.} and Gounis, {Matthew J.} and Chueh, {Ju Yu} and Puri, {Ajit S.} and Mohammed Almekhlafi and Demchuk, {Andrew M.} and Hanel, {Ricardo A.} and Eric Sauvageau and Amin Aghaebrahim and Yoo, {Albert J.} and Peter Kvamme and Pereira, {Vitor M.} and Yasha Kayan and {Delgado Almandoz}, {Josser E.} and Nogueira, {Raul G.} and Rabinstein, {Alejandro A.} and Kallmes, {David F.} and Doyle, {Karen M.} and Waleed Brinjikji",
note = "Funding Information: This work was supported by the National Institutes of Health grant (No. R01 NS105853) and the European Regional Development Fund and Science Foundation Ireland grant (No. 13/RC/2073). Funding Information: The authors declare competing interests (funding, employment, or personal financial interests) in relation to the work described herein. Dr Brinjikji declares competing interests in the form of research grants, National Institutes of Health (no compensation) and ownership interest in Marblehead Medical LLC (significant compensation) and other research support from Johnson and Johnson (no compensation). Dr Kallmes declares competing interests in the form of research grants, National Institutes of Health (no compensation) and ownership interest in Marblehead Medical LLC (significant compensation). Dr Nogueira declares competing interests in the form of Stryker Neurovascular (DAWN Trial [DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With TREVO] Principal Investigator, no compensation; TREVO Registry Steering Committee, no compensation; TREVO-2 Trial Principal Investigator, modest compensation; consultant, modest compensation), Medtronic (SWIFT Trial [The Solitaire With the Intention for Thrombectomy] Steering Committee, modest compensation; SWIFT-Prime Trial Steering Committee, no compensation; STAR Trial [Solitaire FR Thrombectomy for Acute Revascularisation] Angiographic Core Lab, significant compensation), Penumbra (no compensation), Cerenovus/ Neuravi (ENDOLOW Trial Principal Investigator, EXCELLENT Registry Principal Investigator, ARISE-2 Trial [Analysis of Revascularization in Ischemic Stroke With EmboTrap] Steering Committee, no compensation; Physician Advisory Board, modest compensation), Phenox (Physician Advisory Board, modest compensation), Anaconda (Physician Advisory Board, modest compensation), Genentech (Physician Advisory Board, modest compensation), Biogen (Physician Advisory Board, modest compensation), Prolong Pharmaceuticals (Physician Advisory Board, modest compensation), IschemaView (Speaker, modest compensation), Brainomix (Research Software Use, no compensation), Sensome (Research Device Use, no compensation), Viz-AI (Physician Advisory Board, stock options), Philips (Research Software Use, no compensation; Speaker, modest compensation), and Corindus Vascular Robotics (Physician Advisory Board, stock options). Dr Yoo declares competing interests in the form of research grants (all significant compensation): Medtronic, Cerenovus, Penumbra, Stryker, Genentech; employment (modest compensation): Cerenovus, Genentech; and personal financial interests (significant compensation): Insera Therapeutics. Dr Delgado Almandoz declares competing interests in the form of employment (modest compensation) from Medtronic Neurovascular and Penumbra, Inc. Dr Demchuk received honoraria from Medtronic for Continuing Medical Education events. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2019 American Heart Association, Inc.",
year = "2019",
month = jul,
day = "1",
doi = "10.1161/STROKEAHA.118.024543",
language = "English (US)",
volume = "50",
pages = "1907--1910",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "7",
}