Oana Madalina Mereuta1, Rosanna Rossi2, Andrew Douglas3, Sara Molina Gil4, Seán Fitzgerald5, Abhay Pandit6, Ray McCarthy7, Michael Gilvarry8, Eric Ceder9, Dennis Dunker10, Annika Nordanstig11, Petra Redfors12, Katarina Jood13, Georgios Magoufis14, Klearchos Psychogios15, Georgios Tsivgoulis16, Alan O'Hare17, Sarah Power18, Paul Brennan19, András Nagy20, Ágnes Vadász20, Waleed Brinjikji21, David F Kallmes22, Istvan Szikora23, Alexandros Rentzos24, Turgut Tatlisumak25, John Thornton26, Karen M Doyle27. 1. CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland; Physiology Department, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland. Electronic address: oanamadalina.mereuta@nuigalway.ie. 2. CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland; Physiology Department, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland. Electronic address: rosanna.rossi@nuigalway.ie. 3. CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland; Physiology Department, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland. Electronic address: andrew.douglas@nuigalway.ie. 4. CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland; Physiology Department, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland. Electronic address: sara.molinagil@nuigalway.ie. 5. CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland; Physiology Department, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland. Electronic address: sean.fitzgerald@nuigalway.ie. 6. CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland. Electronic address: abhay.pandit@nuigalway.ie. 7. Cerenovus, Galway Neuro Technology Centre, Galway, Ireland. Electronic address: rmccart9@its.jnj.com. 8. Cerenovus, Galway Neuro Technology Centre, Galway, Ireland. Electronic address: mgilvarr@its.jnj.com. 9. Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. Electronic address: erik.ceder@vgregion.se. 10. Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. Electronic address: dennis.dunker@vgregion.se. 11. Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: annika.nordanstig@vgregion.se. 12. Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: petra.redfors@gu.se. 13. Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: katarina.jood@neuro.gu.se. 14. Metropolitan Hospital, Stroke Unit, Piraeus, Greece. Electronic address: magoufis@otenet.gr. 15. Metropolitan Hospital, Stroke Unit, Piraeus, Greece; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece. 16. Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece. 17. Radiology Department, Beaumont Hospital and Royal College of Surgeons Ireland, Dublin, Ireland. Electronic address: alanohare@beaumont.ie. 18. Radiology Department, Beaumont Hospital and Royal College of Surgeons Ireland, Dublin, Ireland. Electronic address: sarahpower@beaumont.ie. 19. Radiology Department, Beaumont Hospital and Royal College of Surgeons Ireland, Dublin, Ireland. Electronic address: paulbrennan@beaumont.ie. 20. Department of Neurointerventions, National Institute of Neurosciences, Budapest, Hungary. 21. Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: brinjikji.waleed@mayo.edu. 22. Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: kallmes.david@mayo.edu. 23. Department of Neurointerventions, National Institute of Neurosciences, Budapest, Hungary. Electronic address: h13424szi@ella.hu. 24. Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. Electronic address: alexandros.rentzos@vgregion.se. 25. Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: turgut.tatlisumak@neuro.gu.se. 26. Radiology Department, Beaumont Hospital and Royal College of Surgeons Ireland, Dublin, Ireland. Electronic address: johnthornton@beaumont.ie. 27. CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland; Physiology Department, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland. Electronic address: karen.doyle@nuigalway.ie.
Abstract
OBJECTIVES: Most clots retrieved from patients with acute ischemic stroke are 'red' in color. 'White' clots represent a less common entity and their histological composition is less known. Our aim was to investigate the composition, imaging and procedural characteristics of 'white' clots retrieved by mechanical thrombectomy. MATERIALS AND METHODS: Seventy five 'white' thrombi were selected by visual inspection from a cohort of 760 clots collected as part of the RESTORE registry. Clots were evaluated histopathologically. RESULTS: Quantification of Martius Scarlett Blue stain identified platelets/other as the major component in 'white' clots' (mean of 55% of clot overall composition) followed by fibrin (31%), red blood cells (6%) and white blood cells (3%). 'White' clots contained significantly more platelets/other (p<0.001*) and collagen/calcification (p<0.001*) and less red blood cells (p<0.001*) and white blood cells (p=0.018*) than 'red' clots. The mean platelet and von Willebrand Factor expression was 43% and 24%, respectively. Adipocytes were found in four cases. 'White' clots were significantly smaller (p=0.016*), less hyperdense (p=0.005*) on computed tomography angiography/non-contrast CT and were associated with a smaller extracted clot area (p<0.001*) than 'red' clots. They primarily caused the occlusion of middle cerebral artery, were less likely to be removed by aspiration and more likely to require rescue-therapy for retrieval. CONCLUSIONS: 'White' clots represented 14% of our cohort and were platelet, von Willebrand Factor and collagen/calcification-rich. 'White' clots were smaller, less hyperdense, were associated with significantly more distal occlusions and were less successfully removed by aspiration alone than 'red' clots.
OBJECTIVES: Most clots retrieved from patients with acute ischemic stroke are 'red' in color. 'White' clots represent a less common entity and their histological composition is less known. Our aim was to investigate the composition, imaging and procedural characteristics of 'white' clots retrieved by mechanical thrombectomy. MATERIALS AND METHODS: Seventy five 'white' thrombi were selected by visual inspection from a cohort of 760 clots collected as part of the RESTORE registry. Clots were evaluated histopathologically. RESULTS: Quantification of Martius Scarlett Blue stain identified platelets/other as the major component in 'white' clots' (mean of 55% of clot overall composition) followed by fibrin (31%), red blood cells (6%) and white blood cells (3%). 'White' clots contained significantly more platelets/other (p<0.001*) and collagen/calcification (p<0.001*) and less red blood cells (p<0.001*) and white blood cells (p=0.018*) than 'red' clots. The mean platelet and von Willebrand Factor expression was 43% and 24%, respectively. Adipocytes were found in four cases. 'White' clots were significantly smaller (p=0.016*), less hyperdense (p=0.005*) on computed tomography angiography/non-contrast CT and were associated with a smaller extracted clot area (p<0.001*) than 'red' clots. They primarily caused the occlusion of middle cerebral artery, were less likely to be removed by aspiration and more likely to require rescue-therapy for retrieval. CONCLUSIONS: 'White' clots represented 14% of our cohort and were platelet, von Willebrand Factor and collagen/calcification-rich. 'White' clots were smaller, less hyperdense, were associated with significantly more distal occlusions and were less successfully removed by aspiration alone than 'red' clots.
Authors: Oskar Aspegren; Senna Staessens; Sarah Vandelanotte; Linda Desender; Charlotte Cordonnier; Laurent Puy; Nicolas Bricout; Simon F De Meyer; Tommy Andersson; Fabian Arnberg Journal: Front Neurol Date: 2022-05-17 Impact factor: 4.086
Authors: Daniela Dumitriu LaGrange; Vincent Braunersreuther; Isabel Wanke; Jatta Berberat; Siri Luthman; Seán Fitzgerald; Karen M Doyle; Olivier Brina; Philippe Reymond; Alexandra Platon; Michel Muster; Paolo Machi; Pierre-Alexandre Poletti; Maria Isabel Vargas; Karl-Olof Lövblad Journal: Front Neurol Date: 2022-03-07 Impact factor: 4.003