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Case series
Clot composition in retrieved thrombi after mechanical thrombectomy in strokes due to carotid web
  1. Sitara Koneru1,2,
  2. Raul G Nogueira1,2,
  3. Ehizele Osehobo1,2,
  4. Gabriela Oprea-Ilies3,
  5. Alhamza R Al-Bayati1,2,
  6. Waleed Brinjikji4,
  7. Daying Dai4,
  8. Diogo C Haussen1,2
  1. 1 Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2 Neurology, Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA
  3. 3 Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4 Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Diogo C Haussen, Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; diogo.haussen{at}emory.edu

Abstract

Background The association of carotid webs (CaW) and ischemic stroke is being increasingly recognized. Data on the histologic clot architecture in strokes caused by CaW has not been previously described. Understanding thrombi histopathology may provide insight into the pathophysiology of CaW-related strokes.

Methods This case series presents three patients with acute ischemic stroke thought to be caused by ipsilateral CaW. Thromboemboli were retrieved from the middle cerebral artery (MCA) by mechanical thrombectomy and histologic analysis was performed.

Results Three patients aged between 41 and 55 years with few to no vascular risk factors presented with symptoms concerning for an acute MCA territory infarction (National Institutes of Health Stroke Scale (NIHSS) range 10–17). Non-contrast computed tomography (CT) Alberta Stroke Program Early CT Score (ASPECTS) range was 7–8 and all patients had hyperdense vessel sign. Initial CT angiogram was concerning for CaW with no superimposed thrombus, later confirmed with conventional angiography. All patients underwent thrombectomy with full reperfusion. Comprehensive stroke workup failed to reveal other etiologies besides ipsilateral CaW. The histopathologic appearance was of typical fresh mixed thrombi. Qualitative thrombus composition analysis of clot from Case #1 yielded 42.5% fibrin, 50.0% red blood cells (RBC), and 7.5% white blood cells (WBC); Case #2 yielded 46.9% fibrin, 43.4% RBC, and 9.7% WBC; and Case #3 yielded 61.5% fibrin, 31.8% RBC, and 6.7% WBC.

Conclusions The clot composition of large vessel occlusion strokes from CaW is comparable to the histopathology of previously reported clots from other stroke etiologies. Advanced staining techniques may aid in further characterizing the thrombi of this poorly understood condition.

  • stroke
  • angiography
  • thrombectomy
  • vessel wall
  • malformation

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Footnotes

  • Twitter @SitaraKoneru

  • Contributors SK was involved in the conception and design of the study, acquisition and analysis of data, and drafted a significant proportion of the manuscript and figures. RGN helped with the conception and design of the study and revised the manuscript for intellectual content. EO was involved in the conception and design of the study and the acquisition and analysis of data. GO-I was involved in the conception and design of the study and the acquisition and analysis of data. ARRA-B was involved in the conception and design of the study and revised the manuscript for intellectual content. WB was involved in the acquisition and analysis of data and revised the manuscript for intellectual content. DD was involved in the acquisition and analysis of data and revised the manuscript for intellectual content. DCH was involved in the conception and design of the study, the acquisition and analysis of data, and revised the manuscript for intellectual content.

  • Funding This study was funded by the National Institutes of Health (grant number R01 NS105853).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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