TY - JOUR
TI - Per-pass analysis of acute ischemic stroke clots: impact of stroke
etiology on extracted clot area and histological composition
AU - Fitzgerald, Sean
AU - Rossi, Rosanna
AU - Mereuta, Oana Madalina and
AU - Jabrah, Duaa
AU - Okolo, Adaobi
AU - Douglas, Andrew
AU - Molina Gil, Sara
AU - and Pandit, Abhay
AU - McCarthy, Ray
AU - Gilvarry, Michael
AU - Dunker,
AU - Dennis
AU - Nordanstig, Annika
AU - Ceder, Erik
AU - Redfors, Petra and
AU - Jood, Katarina
AU - Dehlfors, Niclas
AU - Magoufis, Georgios and
AU - Tsivgoulis, Georgios
AU - Brinjikji, Waleed
AU - Kallmes, David F. and
AU - O'Hare, Alan
AU - Power, Sarah
AU - Brennan, Paul
AU - Alderson, Jack and
AU - Nagy, Andras
AU - Vadasz, Agnes
AU - Psychogios, Klearchos
AU - Szikora,
AU - Istvan
AU - Tatlisumak, Turgut
AU - Rentzos, Alexandros
AU - Thornton, John
AU - and Doyle, Karen M.
JO - Journal of Neurointerventional Surgery
PY - 2021
VL - 13
TODO - 12
SP - 1111+
PB - BMJ Publishing Group
SN - null
TODO - 10.1136/neurintsurg-2020-016966
TODO - thrombectomy; atherosclerosis; intervention; stroke
TODO - 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.
ER -