TY - JOUR
T1 - Platelet-rich emboli are associated with von Willebrand factor levels and have poorer revascularization outcomes
AU - Douglas, Andrew
AU - Fitzgerald, Seán
AU - Mereuta, Oana Madalina
AU - Rossi, Rosanna
AU - O'Leary, Sean
AU - Pandit, Abhay
AU - McCarthy, Ray
AU - Gilvarry, Michael
AU - Holmegaard, Lukas
AU - Abrahamsson, Margareta
AU - Jerndal, Mikael
AU - Dehlfors, Niclas
AU - Brennan, Paul
AU - Power, Sarah
AU - O'Hare, Alan
AU - Griffin, Emma
AU - Kallmes, David F.
AU - Brinjikji, Waleed
AU - Szikora, István
AU - Tatlisumak, Turgut
AU - Rentzos, Alexandros
AU - Thornton, John
AU - Doyle, Karen
N1 - Funding Information:
Funding This work was supported by the european regional Development Fund and science Foundation ireland (grant number 13/rc/2073).
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Background and aims Platelets and von Willebrand factor (vWF) are key factors in thrombosis and thus are likely key components of acute ischemic stroke (AIS) emboli. We aimed to characterize platelet and vWF levels in AIS emboli and to assess associations between their expression levels and clinical and procedural information. Materials and method Histopathological and immunohistochemical analysis of emboli collected as part of the multi-institutional RESTORE registry was performed. The composition of the emboli was quantified using Orbit Image Analysis machine learning software. Correlations between clot components and clinical and procedural information were assessed using the χ 2 test. Results Ninety-one emboli samples retrieved from 63 patients were analyzed in the study. The mean platelet (CD42b) content of the clots was 33.9% and the mean vWF content of the clots was 29.8%. There was a positive correlation between platelet and vWF levels (ρ=0.564, p<0.001∗, n=91). There was an inverse correlation between both platelets and vWF levels and percentage of red blood cells (RBCs) in the emboli (CD42b vs RBC: ρ=-0.535, p<0.001∗, n=91; vWF vs RBC: ρ=-0.366, p<0.001∗, n=91). Eighty-one percent of patients in the low platelet group had a good revascularization outcome (Thrombolysis in Cerebral Infarction 2c/3) compared with 58% in the high platelet group (χ 2 =5.856, p=0.016). Conclusion Platelet and vWF levels in AIS emboli correlate with each other and both have an inverse relationship with RBC composition. Patients with platelet-rich clots have poorer revascularization outcomes.
AB - Background and aims Platelets and von Willebrand factor (vWF) are key factors in thrombosis and thus are likely key components of acute ischemic stroke (AIS) emboli. We aimed to characterize platelet and vWF levels in AIS emboli and to assess associations between their expression levels and clinical and procedural information. Materials and method Histopathological and immunohistochemical analysis of emboli collected as part of the multi-institutional RESTORE registry was performed. The composition of the emboli was quantified using Orbit Image Analysis machine learning software. Correlations between clot components and clinical and procedural information were assessed using the χ 2 test. Results Ninety-one emboli samples retrieved from 63 patients were analyzed in the study. The mean platelet (CD42b) content of the clots was 33.9% and the mean vWF content of the clots was 29.8%. There was a positive correlation between platelet and vWF levels (ρ=0.564, p<0.001∗, n=91). There was an inverse correlation between both platelets and vWF levels and percentage of red blood cells (RBCs) in the emboli (CD42b vs RBC: ρ=-0.535, p<0.001∗, n=91; vWF vs RBC: ρ=-0.366, p<0.001∗, n=91). Eighty-one percent of patients in the low platelet group had a good revascularization outcome (Thrombolysis in Cerebral Infarction 2c/3) compared with 58% in the high platelet group (χ 2 =5.856, p=0.016). Conclusion Platelet and vWF levels in AIS emboli correlate with each other and both have an inverse relationship with RBC composition. Patients with platelet-rich clots have poorer revascularization outcomes.
KW - platelets
KW - stroke
KW - thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85074881790&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85074881790&partnerID=8YFLogxK
U2 - 10.1136/neurintsurg-2019-015410
DO - 10.1136/neurintsurg-2019-015410
M3 - Article
C2 - 31685695
AN - SCOPUS:85074881790
SN - 1759-8478
VL - 12
SP - 557
EP - 562
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 6
ER -