Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 21;13(5):e0197492.
doi: 10.1371/journal.pone.0197492. eCollection 2018.

High red blood cell composition in clots is associated with successful recanalization during intra-arterial thrombectomy

Jong Wook Shin  1   2 , Hye Seon Jeong  1   2 , Hyon-Jo Kwon  1   3 , Kyu Sang Song  4 , Jei Kim  1   2
Affiliations

High red blood cell composition in clots is associated with successful recanalization during intra-arterial thrombectomy

Jong Wook Shin et al. PLoS One. .

Abstract

We evaluated the composition of individual clots retrieved during intra-arterial thrombectomy in relation to recanalization success, stroke subtype, and the presence of clot signs on initial brain images. We analyzed clot and interventional data from 145 retrieval trials performed for 37 patients (69.5±14.0 years, 20 men, large artery atherosclerosis, n = 7; cardioembolism, n = 22; undetermined etiology, n = 8) who had undergone intra-arterial thrombectomy. Rates of clot retrieval and successful recanalization (Arterial Occlusive Lesion score of 2-3) for separate retrieval trials were evaluated. The area occupied by red blood cell (RBC), fibrin/platelets, and white blood cell (WBC) was measured from digitized images of hematoxylin-eosin stained clots. Compositional differences were compared according to recanalization success, stroke subtype, and the presence of hyperdense clot sign on initial computed tomography and/or blooming artifact on magnetic resonance image. Of the 145 total retrieval trials (3.4±2.4 times per patient), clot was retrieved in 93 trials (64%), while recanalization was successful in 73 (50%). Fibrin/platelets (63%) occupied the greatest area in retrieved clots, followed by RBCs (33%) and WBCs (4%). Clots retrieved from successful recanalization exhibited higher RBC composition (37%) than those retrieved from non-recanalization trials (20%, p = 0.001). RBC composition was higher in cardioembolic stroke (38%) rather than large artery atherosclerosis (23%) and undetermined etiology (26%, p = 0.01). Clots exhibiting clot signs (40%) had higher RBC composition than those without clot signs (19%, p = 0.001). RBC-rich clots were associated with successful recanalization of intra-arterial thrombectomy, cardioembolic stroke, and the presence of clot-signs on initial brain images.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Measurement of RBC, fibrin/platelet, and WBC composition using the Positive Pixel Count (PPC) algorithm of the ImageScope program in an RBC-rich clot (A), a mixed clot (B), and a fibrin/platelet-rich clot (C). To measure the area of RBC and fibrin/platelet in a digitized clot image, hue value (0.05), hue width (0.4), saturation (0.04), the intensity of strong positive pixels (Isp, 100), and the intensity of weak positive pixels (Iwp, 215) were set to the fixed values. The intensity of positive pixels (Ip) was only adjusted in a best image of the 10 clot images differently digitized from 135 to 180 of Ip values to obtain the clearest discrimination of RBC and fibrin/platelet in the individual clot images.
Fig 2
Fig 2
Comparison of clot composition (red blood cells [RBCs], fibrin/platelets, white blood cells [WBCs]) in total retrieved clots (A) and in total included patients according to stroke subtype. LAA: Large artery atherosclerosis.
Fig 3
Fig 3
Comparison of clot composition (red blood cells [RBCs], fibrin/platelets, white blood cells [WBCs]) according to recanalization status (A), the presence of clot signs (hyperdense MCA sign on initial computed tomography and/or blooming artifact on initial gradient-echo magnetic resonance images) (B), and the retrieval devices (C).
See this image and copyright information in PMC

References

    1. Mazighi M, Meseguer E, Labreuche J, Serfaty J-M, Laissy J-P, Lavallée PC, et al. Dramatic recovery in acute ischemic stroke is associated with arterial recanalization grade and speed. Stroke. 2012;43:2998–3002 doi: 10.1161/STROKEAHA.112.658849 - DOI - PubMed
    1. Meurer WJ, Barth BE, Gaddis G, Vilke GM, Lam SH. Rapid systematic review: intra-arterial thrombectomy ("clot retrieval") for selected patients with acute ischemic stroke. J Emerg Med. 2017;52:255–261 doi: 10.1016/j.jemermed.2016.10.004 - DOI - PubMed
    1. Khatri P, Abruzzo T, Yeatts SD, Nichols C, Broderick JP, Tomsick TA, et al. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology. 2009;73:1066–10724. doi: 10.1212/WNL.0b013e3181b9c847 - DOI - PMC - PubMed
    1. Jeong HS, Kwon HJ, Song HJ, Koh HS, Kim YS, Lee JH, et al. Impacts of rapid recanalization and collateral circulation on clinical outcome after intraarterial thrombolysis. J Stroke. 2015;17:76–83 doi: 10.5853/jos.2015.17.1.76 - DOI - PMC - PubMed
    1. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al., A randomized trial of intra-arterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20 doi: 10.1056/NEJMoa1411587 - DOI - PubMed

Publication types