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Clot permeability and histopathology: is a clot’s perviousness on CT imaging correlated with its histologic composition?
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  • Published on:
    • John C Benson, Neuoradiologist Mayo Clinic
    • Other Contributors:
      • Waleed Brinjikji, Neuroradiologist

    Dear Editor,
    We would like the thank Drs. Berndt, Zimmer, Kaesmacher, and Boeckh-Behrens for their interest in our study titled “Clot permeability and histopathology: Is a clot’s perviousness on CT imaging correlated with its histologic composition?” We read their letter with interest. The authors have been pioneers in stroke clot analysis and we greatly respect their academic rigor and expertise.

    While we agree that there are certainly some methodological differences between our two studies, we do not believe that these are to blame for the differences in results. Rather, we feel that the observed differences in results between our studies could be due to differences in our patient populations.

    Our group has previously shown that there is indeed a correlation between clot composition and etiology. In a recently published article in Stroke we found that large artery atherosclerosis clots were more likely to be platelet rich than those of a cardioembolic origin.1 To date, however, we have yet to find any definite correlation between etiology and RBC density or fibrin density, and we think it is too early to make any definite conclusions on the association between clot composition and etiology.

    We agree that the association between perviousness, clot composition, etiology and clinical outcome is not conclusively clarified yet, and hence warrants further research, especially in a larger patient group in a multi-centric setting. Currently, our gr...

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    Conflict of Interest:
    None declared.
  • Published on:
    Letter by Berndt et al. Regarding Article “Clot permeability and histopathology: is a clot’s perviousness on CT imaging correlated with its histologic composition?”
    • Maria T. Berndt, Neuroradiologist Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Germany
    • Other Contributors:
      • Claus Zimmer, Neuroradiologist
      • Johannes Kaesmacher, Radiologist
      • Tobias Boeckh-Behrens, Neuroradiologist

    Recently, we have read with great interest the article by Benson et al. “Clot permeability and histopathology: is a clot’s perviousness on CT imaging correlated with its histologic composition?” [1].
    It is pleasing, that research in the field of thrombus characterization by perviousness and its association to thrombus composition is emerging. Benson et al. report a higher clot perviousness for RBC rich clots in comparison to fibrin dominant thrombi [1]. These results stand in contrast to our previously published study [2], that shows an association between perviousness and fibrin rich clots. We furthermore validated those findings in a large collective by showing a relationship between perviousness and cardioembolic origin. Further research to this special topic is scarce. However, there is another experimental and therefore well controllable study on artificial clots, that showed a strong association of fibrin content and contrast agent uptake [3], similar as it has been shown for in vivo thrombi in our study [2].
    Consequently, these contradictory results demand further explanations. In our opinion, the differing results might be caused by methodological differences, which we want to discuss.
    First, thrombus localizations should be taken into account. Benson et al. used a collective of 57 thrombi with different thrombus locations (38 MCA, 6 ICA, 5 ICA/MCA, 3 basilar artery, 2 posterior cerebral artery, 2 ICA/MCA/ACA, 1 ICC/MCA). It is at least questiona...

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    Conflict of Interest:
    None declared.