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Original research
Platelet-rich clots as identified by Martius Scarlet Blue staining are isodense on NCCT
  1. Sean T Fitzgerald1,2,
  2. Shunli Wang3,
  3. Daying Dai1,
  4. Andrew Douglas2,4,
  5. Ramanathan Kadirvel1,
  6. Matthew J Gounis5,
  7. Juyu Chueh5,
  8. Ajit S Puri5,
  9. Kennith F Layton6,
  10. Ike C Thacker6,
  11. Ricardo A Hanel7,
  12. Eric Sauvageau7,
  13. Amin Aghaebrahim7,
  14. Mohammed A Almekhlafi8,
  15. Andrew M Demchuk9,
  16. Raul G Nogueira10,
  17. Vitor M Pereira11,
  18. Peter Kvamme12,
  19. Yasha Kayan13,
  20. Josser E Delgado Almandoz13,
  21. Albert J Yoo14,
  22. David F Kallmes1,
  23. Karen M Doyle2,4,
  24. Waleed Brinjikji1
  1. 1 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 CÚRAM - Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
  3. 3 Department of Pathology, Shanghai East Hospital, Tongji University, Shanghai, China
  4. 4 Department of Physiology, National University of Ireland Galway, Galway, Ireland
  5. 5 Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
  6. 6 Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
  7. 7 Stroke & Cerebrovascular Center, Lyerly Neurosurgery/Baptist Neurological Center, Jacksonville, Florida, USA
  8. 8 Department of Radiology, Hotchkiss Brain Institute, Calgary, Alberta, Canada
  9. 9 Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  10. 10 Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA
  11. 11 Joint Department of Medical Imaging, Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
  12. 12 Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
  13. 13 NeuroInterventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
  14. 14 Department of Neurointervention, Texas Stroke Institute, Plano, Texas, USA
  1. Correspondence to Dr Sean T Fitzgerald, Department of Radiology, Mayo Clinic, Rochester, Minnesota 55902, USA; fitzgerald.sean2{at}mayo.edu

Abstract

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.

  • platelets
  • stroke
  • CT
  • thrombectomy
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Footnotes

  • 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.

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