TY - JOUR
T1 - Per-pass analysis of acute ischemic stroke clots
T2 - Impact of stroke etiology on extracted clot area and histological composition
AU - Fitzgerald, Seán
AU - Rossi, Rosanna
AU - Mereuta, Oana Madalina
AU - Jabrah, Duaa
AU - Okolo, Adaobi
AU - Douglas, Andrew
AU - Molina Gil, Sara
AU - Pandit, Abhay
AU - McCarthy, Ray
AU - Gilvarry, Michael
AU - Dunker, Dennis
AU - Nordanstig, Annika
AU - Ceder, Erik
AU - Redfors, Petra
AU - Jood, Katarina
AU - Dehlfors, Niclas
AU - Magoufis, Georgios
AU - Tsivgoulis, Georgios
AU - Brinjikji, Waleed
AU - Kallmes, David F.
AU - O'Hare, Alan
AU - Power, Sarah
AU - Brennan, Paul
AU - Alderson, Jack
AU - Nagy, András
AU - Vadász, Ágnes
AU - Psychogios, Klearchos
AU - Szikora, Istvan
AU - Tatlisumak, Turgut
AU - Rentzos, Alexandros
AU - Thornton, John
AU - Doyle, Karen M.
N1 - Funding Information:
Funding This work was supported by the European Regional Development Fund and Science Foundation Ireland grant number (13/RC/2073) and by the National Institutes of Health grant number (R01 NS105853).
Funding Information:
Competing interests The authors declare competing interests (funding, employment or personal financial interests) in relation to the work described herein. KD received research funding support from Science Foundation Ireland that is co-funded by Cerenovus.
Publisher Copyright:
©
PY - 2021
Y1 - 2021
N2 - Background Initial studies investigating correlations between stroke etiology and clot composition are conflicting and do not account for clot size as determined by area. Radiological studies have shown that cardioembolic strokes are associated with shorter clot lengths and lower clot burden than non-cardioembolic clots. Objective To report the relationship between stroke etiology, extracted clot area, and histological composition at each procedural pass. Methods As part of the multi-institutional RESTORE Registry, the Martius Scarlett Blue stained histological composition and extracted clot area of 612 per-pass clots retrieved from 441 patients during mechanical thrombectomy procedures were quantified. Correlations with clinical and procedural details were investigated. Results Clot composition varied significantly with procedural passes; clots retrieved in earlier passes had higher red blood cell content (H4=11.644, p=0.020) and larger extracted clot area (H4=10.730, p=0.030). Later passes were associated with significantly higher fibrin (H4=12.935, p=0.012) and platelets/other (H4=15.977, p=0.003) content and smaller extracted clot area. Large artery atherosclerotic (LAA) clots were significantly larger in the extracted clot area and more red blood cell-rich than other etiologies in passes 1-3. Cardioembolic and cryptogenic clots had similar histological composition and extracted clot area across all procedural passes. Conclusion LAA clots are larger and associated with a large red blood cell-rich extracted clot area, suggesting soft thrombus material. Cardioembolic clots are smaller in the extracted clot area, consistent in composition and area across passes, and have higher fibrin and platelets/other content than LAA clots, making them stiffer clots. The per-pass histological composition and extracted clot area of cryptogenic clots are similar to those of cardioembolic clots, suggesting similar formation mechanisms.
AB - Background Initial studies investigating correlations between stroke etiology and clot composition are conflicting and do not account for clot size as determined by area. Radiological studies have shown that cardioembolic strokes are associated with shorter clot lengths and lower clot burden than non-cardioembolic clots. Objective To report the relationship between stroke etiology, extracted clot area, and histological composition at each procedural pass. Methods As part of the multi-institutional RESTORE Registry, the Martius Scarlett Blue stained histological composition and extracted clot area of 612 per-pass clots retrieved from 441 patients during mechanical thrombectomy procedures were quantified. Correlations with clinical and procedural details were investigated. Results Clot composition varied significantly with procedural passes; clots retrieved in earlier passes had higher red blood cell content (H4=11.644, p=0.020) and larger extracted clot area (H4=10.730, p=0.030). Later passes were associated with significantly higher fibrin (H4=12.935, p=0.012) and platelets/other (H4=15.977, p=0.003) content and smaller extracted clot area. Large artery atherosclerotic (LAA) clots were significantly larger in the extracted clot area and more red blood cell-rich than other etiologies in passes 1-3. Cardioembolic and cryptogenic clots had similar histological composition and extracted clot area across all procedural passes. Conclusion LAA clots are larger and associated with a large red blood cell-rich extracted clot area, suggesting soft thrombus material. Cardioembolic clots are smaller in the extracted clot area, consistent in composition and area across passes, and have higher fibrin and platelets/other content than LAA clots, making them stiffer clots. The per-pass histological composition and extracted clot area of cryptogenic clots are similar to those of cardioembolic clots, suggesting similar formation mechanisms.
KW - atherosclerosis
KW - intervention
KW - stroke
KW - thrombectomy
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U2 - 10.1136/neurintsurg-2020-016966
DO - 10.1136/neurintsurg-2020-016966
M3 - Article
C2 - 33298510
AN - SCOPUS:85097521507
SN - 1759-8478
VL - 13
SP - 1111
EP - 1116
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 12
ER -