RT Journal Article
SR Electronic
T1 Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the Stroke Thromboembolism Registry of Imaging and Pathology
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 594
OP 598
DO 10.1136/neurintsurg-2020-017167
VO 13
IS 7
A1 Waleed Brinjikji
A1 Raul G Nogueira
A1 Peter Kvamme
A1 Kennith F Layton
A1 Josser E Delgado Almandoz
A1 Ricardo A Hanel
A1 Vitor Mendes Pereira
A1 Mohammed A Almekhlafi
A1 Albert J Yoo
A1 Babak S Jahromi
A1 Matthew J Gounis
A1 Biraj Patel
A1 Mehdi Abbasi
A1 Seán Fitzgerald
A1 Oana Madalina Mereuta
A1 Daying Dai
A1 Ramanathan Kadirvel
A1 Karen Doyle
A1 Luis Savastano
A1 Harry J Cloft
A1 Diogo C Haussen
A1 Alhamza R Al-Bayati
A1 Mahmoud H Mohammaden
A1 Leonardo Pisani
A1 Gabriel Martins Rodrigues
A1 Ike C Thacker
A1 Yasha Kayan
A1 Alexander Copelan
A1 Amin Aghaebrahim
A1 Eric Sauvageau
A1 Andrew M Demchuk
A1 Parita Bhuva
A1 Jazba Soomro
A1 Pouya Nazari
A1 Donald Robert Cantrell
A1 Ajit S Puri
A1 John Entwistle
A1 Eric C Polley
A1 David F Kallmes
YR 2021
UL http://jnis.bmj.com/content/13/7/594.abstract
AB 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±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.Data pertaining to this study are available upon reasonable request to the corresponding author.