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Original research
Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the Stroke Thromboembolism Registry of Imaging and Pathology
  1. Waleed Brinjikji1,2,
  2. Raul G Nogueira3,
  3. Peter Kvamme4,
  4. Kennith F Layton5,
  5. Josser E Delgado Almandoz6,
  6. Ricardo A Hanel7,
  7. Vitor Mendes Pereira8,
  8. Mohammed A Almekhlafi9,
  9. Albert J Yoo10,
  10. Babak S Jahromi11,
  11. Matthew J Gounis12,
  12. Biraj Patel13,
  13. Mehdi Abbasi1,
  14. Seán Fitzgerald14,15,
  15. Oana Madalina Mereuta14,15,
  16. Daying Dai1,
  17. Ramanathan Kadirvel1,
  18. Karen Doyle14,15,
  19. Luis Savastano2,
  20. Harry J Cloft1,
  21. Diogo C Haussen3,
  22. Alhamza R Al-Bayati3,
  23. Mahmoud H Mohammaden3,
  24. Leonardo Pisani3,
  25. Gabriel Martins Rodrigues3,
  26. Ike C Thacker5,
  27. Yasha Kayan6,
  28. Alexander Copelan6,
  29. Amin Aghaebrahim7,
  30. Eric Sauvageau7,
  31. Andrew M Demchuk9,
  32. Parita Bhuva10,
  33. Jazba Soomro10,
  34. Pouya Nazari11,
  35. Donald Robert Cantrell11,
  36. Ajit S Puri16,
  37. John Entwistle13,
  38. Eric C Polley17,
  39. David F Kallmes1
  1. 1Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Neurosurgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
  3. 3Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
  5. 5NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
  6. 6Interventional Neuroradiology, Abbot Northwestern Hospital, 55435, Minnesota, USA
  7. 7Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
  8. 8Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
  9. 9Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  10. 10Neurointervention, Texas Stroke Institute, Plano, Texas, USA
  11. 11Neurosurgery and Radiology, Northwestern University, Chicago, Illinois, USA
  12. 12Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  13. 13Radiology, Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
  14. 14CÚRAM–SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
  15. 15Physiology Department, National University of Ireland Galway, Galway, Ireland
  16. 16Radiology, University of Massachusetts, Worcester, Massachusetts, USA
  17. 17Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
  1. Correspondence to Dr Waleed Brinjikji, Mayo Clinic Minnesota, Rochester, MN 55905, USA; Brinjikji.Waleed{at}


Background We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients to study the association between histological composition and stroke etiology

Methods Consecutive patients enrolled in the Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) were included in this study. All patients underwent mechanical thrombectomy and retrieved clots were sent to a central core lab for processing. Histological analysis was performed using martius scarlet blue (MSB) staining, and quantification for red blood cells (RBCs), white blood cells (WBCs), fibrin and platelets was performed using Orbit Image Software. A Wilcoxon test was used for continuous variables and χ2 test for categorical variables.

Results 1350 patients were included in this study. The overall rate of Thrombolysis In Cerebral Infarction (TICI) 2c/3 was 68%. 501 patients received tissue plasminogen activator (tPA) (37%). 267 patients (20%) had a large artery atherosclerosis (LAA) source, 662 (49%) a cardioembolic (CE) source, 301 (22%) were cryptogenic, and the remainder had other identifiable sources including hypercoagulable state or dissection. LAA thrombi had a higher mean RBC density (46±23% vs 42±22%, p=0.01) and a lower platelet density (24±18% vs 27±18%, p=0.03) than CE thrombi. Clots from dissection patients had the highest mean RBC density (50±24%) while clots from patients with a hypercoagulable state had the lowest mean RBC density (26±21%).

Conclusions Our study found statistically significant but clinically insignificant differences between clots of CE and LAA etiologies. Future studies should emphasize molecular, proteomic and immunohistochemical characteristics to determine links between clot composition and etiology.

  • thrombectomy
  • stroke

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  • Twitter @VitorMendesPer1, @AlmekhlafiMa, @FitzSeanT, @PouyaNazari5

  • WB and MA contributed equally.

  • Contributors All authors have reviewed and approved the contents of this manuscript. This study is the result of a multicenter registry requiring the collaboration of multiple neurointerventionalists, research fellows and histopathologists and all authors meet the ICJME criteria for authorship.

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

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

  • Data availability statement Data pertaining to this study are available upon reasonable request to the corresponding author.

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