Background We performed a multicenter prospective clinical registry across 12 centers to study the association between histopathological characteristics of retrieved clots and imaging, stroke etiology and clinical outcomes.
Materials and Methods Following IRB approval at the 12 centers, patients were enrolled in the STRIP registry. All retrieved emboli were sent for histopathological analysis with H&E and MSB staining. Demographic variables, comorbidities, stroke etiology, imaging findings and procedural details were collected for each case. We studied the association between clot histopathology and imaging findings, stroke etiology and and revascularization outcomes. Student’s t-test was used for continuous variables and chi-squared testing for categorical variables.
Results To date, 1457 patients have been included. Platelet rich clots were associated with a significantly lower rate of first pass TICI 2c/3 revascularization than platelet poor clots (OR=0.68, 95%CI=0.48–0.88, P<0.0001). The rate of first pass TICI 2c/3 recanalization was 41% with aspiration compared to 26% for stent-triever and 15% for combined techniques with platelet rich clots (P<0.0001). There was a significant correlation between platelet rich clots and the absence of hyperdensity on non-contrast CT (p=0.003) and a significant inverse correlation between the percentage of platelets and mean HU on NCCT (r=-0.243, p=0.005). We found that a Hounsfield unit cutoff of 55 or less had a sensitivity and specificity of 70% for a platelet rich clot. We did not notice any interaction between clot composition and stroke etiology.
Conclusions Interim analysis of the STRIP registry suggests that the platelet content of a clot may be the most revealing factor in determining a clot’s imaging features and revascularization outcome. Platelet rich clots are less dense on NCCT and are associated with poorer first pass TICI 2c/3. Aspiration therapy was associated with higher rates of first pass recanalization than stent-retriever thrombectomy or combined techniques.
Disclosures W. Brinjikji: None. R. Nogueira: None. R. Hanel: None. K. Layton: None. J. Delgado: None. M. Gounis: None. A. Yoo: None. V. Pereira: None. M. Almekhlafi: None. K. Doyle: None. B. Patel: None. B. Jahromi: None. P. Kvamme: None. R. Kadirvel: None. D. Dai: None. D. Kallmes: None. S. Fitzgerald: None.
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