BACKGROUND AND PURPOSE: Information regarding the histological structure of thromboemboli that cause acute stroke provides insight into pathogenesis and clinical management. METHODS: This report describes the histological analysis of thromboemboli retrieved by endovascular mechanical extraction from the middle cerebral artery (MCA) and intracranial carotid artery (ICA) of 25 patients with acute ischemic stroke. RESULTS: The large majority (75%) of thromboemboli shared architectural features of random fibrin:platelet deposits interspersed with linear collections of nucleated cells (monocytes and neutrophils) and confined erythrocyte-rich regions. This histology was prevalent with both cardioembolic and atherosclerotic sources of embolism. "Red" clots composed uniquely of erythrocytes were uncommon and observed only with incomplete extractions, and cholesterol crystals were notably absent. The histology of thromboemboli that could not be retrieved from 29 concurrent patients may be different. No thrombus >3 mm wide caused stroke limited to the MCA, and no thrombus >5 mm wide was removed from the ICA. A mycotic embolus was successfully removed in 1 case, and a small atheroma and attached intima were removed without clinical consequence from another. CONCLUSIONS: Thromboemboli retrieved from the MCA or intracranial ICA of patients with acute ischemic stroke have similar histological components, whether derived from cardiac or arterial sources. Embolus size determines ultimate destination, those >5 mm wide likely bypassing the cerebral vessels entirely. The fibrin:platelet pattern that dominates thromboembolic structure provides a foundation for both antiplatelet and anticoagulant treatment strategies in stroke prevention.
BACKGROUND AND PURPOSE: Information regarding the histological structure of thromboemboli that cause acute stroke provides insight into pathogenesis and clinical management. METHODS: This report describes the histological analysis of thromboemboli retrieved by endovascular mechanical extraction from the middle cerebral artery (MCA) and intracranial carotid artery (ICA) of 25 patients with acute ischemic stroke. RESULTS: The large majority (75%) of thromboemboli shared architectural features of random fibrin:platelet deposits interspersed with linear collections of nucleated cells (monocytes and neutrophils) and confined erythrocyte-rich regions. This histology was prevalent with both cardioembolic and atherosclerotic sources of embolism. "Red" clots composed uniquely of erythrocytes were uncommon and observed only with incomplete extractions, and cholesterol crystals were notably absent. The histology of thromboemboli that could not be retrieved from 29 concurrent patients may be different. No thrombus >3 mm wide caused stroke limited to the MCA, and no thrombus >5 mm wide was removed from the ICA. A mycotic embolus was successfully removed in 1 case, and a small atheroma and attached intima were removed without clinical consequence from another. CONCLUSIONS:Thromboemboli retrieved from the MCA or intracranial ICA of patients with acute ischemic stroke have similar histological components, whether derived from cardiac or arterial sources. Embolus size determines ultimate destination, those >5 mm wide likely bypassing the cerebral vessels entirely. The fibrin:platelet pattern that dominates thromboembolic structure provides a foundation for both antiplatelet and anticoagulant treatment strategies in stroke prevention.
Authors: I Yuki; I Kan; H V Vinters; R H Kim; A Golshan; F A Vinuela; J W Sayre; Y Murayama; F Vinuela Journal: AJNR Am J Neuroradiol Date: 2011-12-29 Impact factor: 3.825
Authors: R Bourcier; S Volpi; B Guyomarch; B Daumas-Duport; A Lintia-Gaultier; C Papagiannaki; J M Serfaty; H Desal Journal: AJNR Am J Neuroradiol Date: 2015-08-27 Impact factor: 3.825
Authors: Liangfu Zhu; David S Liebeskind; Reza Jahan; Sidney Starkman; Noriko Salamon; Gary Duckwiler; Fernando Vinuela; Satoshi Tateshima; Nestor Gonzalez; Pablo Villablanca; Latisha K Ali; Doojin Kim; Bruce Ovbiagele; Michael Froehler; Matthew Tenser; Jeffrey L Saver Journal: Stroke Date: 2012-01-26 Impact factor: 7.914
Authors: Kenneth B Bader; Kevin J Haworth; Himanshu Shekhar; Adam D Maxwell; Tao Peng; David D McPherson; Christy K Holland Journal: Phys Med Biol Date: 2016-06-29 Impact factor: 3.609
Authors: Azzdine Y Ammi; T Douglas Mast; I-Hua Huang; Todd A Abruzzo; Constantin-C Coussios; George J Shaw; Christy K Holland Journal: Ultrasound Med Biol Date: 2008-05-23 Impact factor: 2.998