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Original research
Association between acute ischemic stroke etiology and macroscopic aspect of retrieved clots: is a clot’s color a warning light for underlying pathologies?
  1. Alessandro Sgreccia1,
  2. Zoé Duchmann2,
  3. Jean Philippe Desilles3,
  4. Bertrand Lapergue4,
  5. Julien Labreuche5,
  6. Maeva Kyheng5,
  7. Romain Bourcier2,
  8. Arturo Consoli4
  9. the COMPO-Clot Investigators
  1. 1 Neuroradiology - Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  2. 2 Department of Diagnostic and Interventional Neuroradiology, Hopital Guillaume et Rene Laennec, Nantes, France
  3. 3 Laboratory of Vascular Translational Science INSERM U1148, Fondation Rothschild, Paris, France
  4. 4 Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, Hospital Foch, University of Versailles and Saint Quentin en Yvelines, Suresnes, France
  5. 5 Santé publique : épidémiologie et qualité des soins, F-59000, CHU Lille, University of Lille EA2694, Lille, France
  1. Correspondence to Dr Alessandro Sgreccia, Radiology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Senigallia, 60019, Italy; a.sgreccia{at}


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.

  • infection
  • stroke
  • thrombectomy
  • tumor
  • intervention

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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.