Background Current studies on clot characterization in acute ischemic stroke focus on fibrin and red blood cell composition. Few studies have examined platelet composition in acute ischemic stroke clots. We characterize clot composition using the Martius Scarlet Blue stain and assess associations between platelet density and CT density.
Materials and method Histopathological analysis of the clots collected as part of the multi-institutional STRIP registry was performed using Martius Scarlet Blue stain and the composition of the clots was quantified using Orbit Image Analysis (www.orbit.bio) machine learning software. Prior to endovascular treatment, each patient underwent non-contrast CT (NCCT) and the CT density of each clot was measured. Correlations between clot components and clinical information were assessed using the χ2 test.
Results Eighty-five patients were included in the study. The mean platelet density of the clots was 15.7% (2.5–72.5%). There was a significant correlation between platelet-rich clots and the absence of hyperdensity on NCCT, (ρ=0.321, p=0.003*, n=85). Similarly, there was a significant inverse correlation between the percentage of platelets and the mean Hounsfield Units on NCCT (ρ=−0.243, p=0.025*, n=85).
Conclusion Martius Scarlet Blue stain can identify patients who have platelet-rich clots. Platelet-rich clots are isodense on NCCT.
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STF and SW contributed equally.
Contributors STF, DFK, DK, RK, and WB were all involved in all stages of the manuscript from concept design to drafting the manuscript. SW, DD, and AD contributed to the histological staining and quantification of the cases. MJG, JC, and ASP collected clots and extracted corresponding clinical data at University of Massachusetts Medical School. KFL and ICT collected clots and extracted corresponding clinical data at Baylor University Medical Center. RH, ES, and AA collected clots and extracted corresponding clinical data at Lyerly Neurosurgery/Baptist Neurological Institute. MAA and AMD collected clots and extracted corresponding clinical data at University of Calgary. RN collected clots and extracted corresponding clinical data at Grady Memorial Hospital and Emory University. VMP collected clots and extracted corresponding clinical data at Toronto Western Hospital. PK collected clots and extracted corresponding clinical data at University of Tennessee Medical Center. JEDA and YK collected clots and extracted corresponding clinical data at Abbott Northwestern Hospital. AJY collected clots and extracted corresponding clinical data at Texas Stroke Institute. All other authors reviewed, edited, and approved the final manuscript prior to submission.
Funding This work was supported by the National Institutes of Health grant number (R01 NS105853) and the European Regional Development Fund and Science Foundation Ireland grant number (13/RC/2073).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Deidentified participant data and corresponding histological data will be made available upon reasonable request.
Patient consent for publication Not required.