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Case Reports
. 2021 Oct 13;21(1):398.
doi: 10.1186/s12883-021-02428-w.

Histologic differences between in situ and embolized carotid web thrombi: a case report

Qun Gao  1   2 , Shen Hu  1 , Ximeng Yang  1 , Junjie Wang  1 , Jun Lu #  3   4 , Daming Wang #  5   6
Affiliations
Case Reports

Histologic differences between in situ and embolized carotid web thrombi: a case report

Qun Gao et al. BMC Neurol. .

Abstract

Background: The significance of carotid webs (CaWs) in ischemic stroke is becoming acknowledged. Histological features of clot composition in situ and secondary cerebrovascular embolized thrombi caused by CaW have not been described concurrently. Understanding clots' histological composition is essential for understanding the pathophysiology of clot formation in CaW.

Case presentation: A 50-year-old male patient with acute ischemic stroke, which was believed to be caused by ipsilateral CaW, was admitted to the hospital. Mechanical thrombectomy was used to retrieve thromboemboli from the middle cerebral artery. One month thereafter, the patient underwent carotid endarterectomy, and in situ CaW thrombi were retrieved. Histological analysis by hematoxylin and eosin staining revealed that histopathologic embolized thrombi appeared as typical mixed thrombi, 46.03% fibrin/platelet ratio, 48.12% RBCs, and 5.85% white blood cells. In situ thrombi had a higher fibrin/platelet ratio (68.0%), fewer RBCs (17.2%), and 14.8% white blood cells.

Conclusion: The histopathology of large vessel occlusion stroke embolized thrombi by CaW is similar to that of other stroke etiologies. However, the clot composition of embolized thrombi significantly differs from that of in situ thrombi. CaW's in situ thrombi showed predominantly fibrin, and embolized thrombi had equivalent contents of red blood cells and fibrin/platelets. Histopathological differences between in situ and embolized thrombi suggest new research directions for the etiology of embolization. Further studies are required to confirm these results.

Keywords: Acute ischemic stroke; Carotid web; Embolized thrombus; Histopathology; In situ thrombus.

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Conflict of interest statement

The authors declared no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
a, b CTA and DSA images of carotid artery webs showing a thin, membrane-like structure (white arrow) in the carotid bulb. c A right internal carotid angiogram demonstrating MCA occlusion. d Mechanical thrombectomy achieved recanalization of the right MCA
Fig. 2
Fig. 2
Gross specimen (a1, b1), H&E staining (a2, b2) and clot analysis (a3, b3, c). (a1) Retrieved clots from the right MCA, (b1) CaW superimposed thrombus after CEA. (a2, b2) H&E-stained sections of retrieved cerebrovascular embolized clots and in situ thrombi magnified 40x. H&E staining showing red blood cells (red), fibrin/platelets (pink), and white blood cells (blue). (a3,b3, c) The relative proportion of red blood cells, fibrin, and platelets was quantified using the Orbit Imaging Analysis Software based on H&E staining, in situ thrombi magnified 100x. *, cranialis; red arrow, thrombus along the web; green arrow, web; yellow arrow, fatty streak
See this image and copyright information in PMC

References

    1. Kim SJ, Nogueira RG, Haussen DC. Current understanding and gaps in research of carotid webs in ischemic strokes: a review. JAMA Neurol. 2019;76(3):355–361. doi: 10.1001/jamaneurol.2018.3366. - DOI - PubMed
    1. Joux J, et al. Carotid-bulb atypical fibromuscular dysplasia in young afro-Caribbean patients with stroke. Stroke. 2014;45(12):3711–3713. doi: 10.1161/STROKEAHA.114.007313. - DOI - PubMed
    1. Joux J, et al. Association between carotid bulb diaphragm and ischemic stroke in young afro-Caribbean patients: a population-based case-control study. Stroke. 2016;47(10):2641–2644. doi: 10.1161/STROKEAHA.116.013918. - DOI - PubMed
    1. Choi PM, et al. Carotid webs and recurrent ischemic strokes in the era of CT angiography. AJNR Am J Neuroradiol. 2015;36(11):2134–2139. doi: 10.3174/ajnr.A4431. - DOI - PMC - PubMed
    1. Sumi T, et al. Disturbed blood flow induces erosive injury to smooth muscle cell-rich neointima and promotes thrombus formation in rabbit femoral arteries. J Thromb Haemost. 2010;8(6):1394–1402. doi: 10.1111/j.1538-7836.2010.03843.x. - DOI - PubMed

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