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. 2020 Oct 21;20(1):383.
doi: 10.1186/s12883-020-01969-w.

Clot composition of embolic strokes of undetermined source: a feasibility study

Amre Nouh  1 , Tapan Mehta  2   3 , Mohamed Hussain  2   4 , Xianyuan Song  5 , Martin Ollenschleger  4
Affiliations

Clot composition of embolic strokes of undetermined source: a feasibility study

Amre Nouh et al. BMC Neurol. .

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: Clot; Cryptogenic stroke; Embolic stroke of undetermined source; Large vessel occlusion; Mechanical Thrombectomy.

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Conflict of interest statement

No authors have relevant conflict of interest disclosures.

Figures

Fig. 1
Fig. 1
Histopathologic stained specimen of a clot. Stained slides were scanned at 200x magnification by using a Scanscope XT digital scanner (Apergio, Vista, California). Panel A with Hematoxylin-eosin to identify red blood cells (RBC’s) staining pink. Panel B CD61 (LifeSpan Biosciences, Seattle, Washington) antibodies for platelet glycoprotein IIIa staining brown
See this image and copyright information in PMC

References

    1. Alberts MJ, Ollenschleger MA, Nouh A. DAWN of a new era for stroke treatment: implications of the DAWN study for acute stroke care and stroke Systems of Care. Circulation. 2018;137(17):1767–1769. - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early Management of Patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110. - PubMed
    1. Brinjikji W, Duffy S. BurrowsA, et al. correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review. J Neurointerv Surg. 2017;9(6):529–534. - PMC - PubMed
    1. Nouh A, Hussain M, Mehta T, Yaghi S. Embolic strokes of unknown source and cryptogenic stroke: implications in clinical practice. Front Neurol. 2016;7:37. - PMC - PubMed
    1. Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13(4):429–438. - PubMed