期刊
JOURNAL OF NEUROINTERVENTIONAL SURGERY
卷 13, 期 7, 页码 594-598出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/neurintsurg-2020-017167
关键词
thrombectomy; stroke
资金
- National Institutes of Health [R01 NS105853]
This retrospective study evaluated clot composition from ischemic stroke patients and found statistically significant, but clinically insignificant differences between clots associated with large artery atherosclerosis (LAA) and cardioembolic (CE) etiologies. Future research should focus on molecular, proteomic, and immunohistochemical characteristics to determine the links between clot composition and stroke etiology.
Background We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients to study the association between histological composition and stroke etiology Methods 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 chi(2) 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.
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