Clot composition of embolic strokes of undetermined source: a feasibility study
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RESEARCH ARTICLE
Open Access
Clot composition of embolic strokes of undetermined source: a feasibility study Amre Nouh1* , Tapan Mehta1,2, Mohamed Hussain1,3, Xianyuan Song4 and Martin Ollenschleger3
Abstract Background: A number of emerging studies have evaluated clot composition in acute ischemic stroke. Studies of clot composition of embolic strokes of undetermined strokes are lacking. Objectives: We sought to analyze the RBC to platelet ratios in clots and correlated our findings with stroke etiology. Methods: This was a prospective study analyzing clots retrieved by mechanical thrombectomy in acute ischemic stroke patients at our institution. All clots were stained and scanned at 200x magnification by using a Scanscope XT digital scanner (Apergio, Vista, California). Image-J software (National Institutes of Health, Bethesda, Maryland) was used for semi quantitative analysis of percentage RBC’s and platelets. Unpaired t-test was used to compare means of RBC to Platelet ratios. Correlation of RBC to Platelet ratios with stroke etiology was performed. Results: A total of 33 clots from 33 patients were analyzed. Stroke etiology was undetermined in 6 patients, cardioembolic in 14, large vessel atherosclerosis (LVA) in 9, and carotid dissection in 4. The mean RBC to platelet ratio was 0.78:1 (+/− 0.65) in cardioembolic clots, 1.73:1 (+/− 2.38) in LVA and 1.4:1(+/− 0.70) in carotid dissections. Although patients with undetermined etiology had a similar clot composition to cardioembolic stroke (0.36:1+/− 0.33), (p = 0.19), it differed significantly from LVA and dissections respectively (p = 0.037, p = 0.01). Conclusion: In our study, a low RBC to Platelet ratio was found among patients with embolic strokes of undetermined source, however shared similar characteristics with cardioembolic thrombi. Ongoing collection and analysis is needed to confirm these findings and its significance in evaluating stroke etiology. Keywords: Embolic stroke of undetermined source, Mechanical Thrombectomy, Large vessel occlusion, Cryptogenic stroke, Clot
Background As the treatment of acute ischemic stroke in patients with large vessel occlusion (LVO) has established the efficacy of mechanical thrombectomy, the number of clot retrievals have increased and will continue to rise as the window for endovascular intervention has been expanded to 24 h from symptom onset in eligible patients [1, 2]. In turn, an increase in the number of emerging * Correspondence: [email protected] 1 Department of Neurology, Hartford Hospital, University of Connecticut, 80 Seymour Street, Hartford, CT 06115, USA Full list of author information is available at the end of the article
studies analyzing retrieved clots for histopathological makeup and the clinical significance they harbor has been observed. Most frequently, studies have reported the relationship between clot histology; angiographic outcomes post thrombectomy, imaging characteristics during acute stroke and ultimately stroke etiology. A large meta-analysis that reviewed over 25 studies and
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