Background Few case reports have considered the chromatic aspect of retrieved clots and the possible association with their underlying etiology.
Objective The aim of our study was to analyze the frequency of the TOAST ischemic stroke typical (atrial fibrillation, dissection, atheroma) and atypical (infective endocarditis, cancer-related, valve-related thrombi) etiologies depending on the chromatic aspect of retrieved clots.
Methods A total of 255 anonymized and standardized clot photos of consecutive patients treated by mechanical thrombectomy for acute ischemic stroke were included. A double-blind evaluation was performed by two senior interventional neuroradiologists, who classified the visual aspects of the clots into two main patterns: red/black or white. Main patient characteristics, distribution of underlying stroke etiologies, and outcomes were compared between the two study groups.
Results The inter-reader agreement for clot colors was excellent (k=0.78). Two hundred and thirty-three patients were classified as having red/black clots and 22 as having white clots. A statistically significant association (p=0.001) between atypical etiologies and white clots was observed.
Conclusions White clots were significantly associated with atypical etiologies in this cohort,in particular, with infectious endocarditis.
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Contributors All the authors participated with substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. All the authors participated drafting the work or revising it critically for important intellectual content, they gave the final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All the data are presented in the manuscript and in the supplemental material and are available upon reasonable request to the corresponding author.
Patient consent for publication Not required.