@article {Brinjikji594, author = {Waleed Brinjikji and Raul G Nogueira and Peter Kvamme and Kennith F Layton and Josser E Delgado Almandoz and Ricardo A Hanel and Vitor Mendes Pereira and Mohammed A Almekhlafi and Albert J Yoo and Babak S Jahromi and Matthew J Gounis and Biraj Patel and Mehdi Abbasi and Se{\'a}n Fitzgerald and Oana Madalina Mereuta and Daying Dai and Ramanathan Kadirvel and Karen Doyle and Luis Savastano and Harry J Cloft and Diogo C Haussen and Alhamza R Al-Bayati and Mahmoud H Mohammaden and Leonardo Pisani and Gabriel Martins Rodrigues and Ike C Thacker and Yasha Kayan and Alexander Copelan and Amin Aghaebrahim and Eric Sauvageau and Andrew M Demchuk and Parita Bhuva and Jazba Soomro and Pouya Nazari and Donald Robert Cantrell and Ajit S Puri and John Entwistle and Eric C Polley and David F Kallmes}, title = {Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the Stroke Thromboembolism Registry of Imaging and Pathology}, volume = {13}, number = {7}, pages = {594--598}, year = {2021}, doi = {10.1136/neurintsurg-2020-017167}, publisher = {British Medical Journal Publishing Group}, abstract = {Background We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients to study the association between histological composition and stroke etiologyMethods 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{\textpm}23\% vs 42{\textpm}22\%, p=0.01) and a lower platelet density (24{\textpm}18\% vs 27{\textpm}18\%, p=0.03) than CE thrombi. Clots from dissection patients had the highest mean RBC density (50{\textpm}24\%) while clots from patients with a hypercoagulable state had the lowest mean RBC density (26{\textpm}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.Data pertaining to this study are available upon reasonable request to the corresponding author.}, issn = {1759-8478}, URL = {https://jnis.bmj.com/content/13/7/594}, eprint = {https://jnis.bmj.com/content/13/7/594.full.pdf}, journal = {Journal of NeuroInterventional Surgery} }