Association between clot composition and stroke origin in mechanical thrombectomy patients: Analysis of the Stroke Thromboembolism Registry of Imaging and Pathology

Waleed Brinjikji*, Raul G. Nogueira, Peter Kvamme, Kennith F. Layton, Josser E.Delgado Almandoz, Ricardo A. Hanel, Vitor Mendes Pereira, Mohammed A. Almekhlafi, Albert J. Yoo, Babak S. Jahromi, Matthew J. Gounis, Biraj Patel, Mehdi Abbasi, Seán Fitzgerald, Oana Madalina Mereuta, Daying Dai, Ramanathan Kadirvel, Karen Doyle, Luis Savastano, Harry J. CloftDiogo C. Haussen, Alhamza R. Al-Bayati, Mahmoud H. Mohammaden, Leonardo Pisani, Gabriel Martins Rodrigues, Ike C. Thacker, Yasha Kayan, Alexander Copelan, Amin Aghaebrahim, Eric Sauvageau, Andrew M. Demchuk, Parita Bhuva, Jazba Soomro, Pouya Nazari, Donald Robert Cantrell, Ajit S. Puri, John Entwistle, Eric C. Polley, David F. Kallmes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Background We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients to study the association between histological composition and stroke etiology Methods Consecutive patients enrolled in the Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) were included in this study. All patients underwent mechanical thrombectomy and retrieved clots were sent to a central core lab for processing. Histological analysis was performed using martius scarlet blue (MSB) staining, and quantification for red blood cells (RBCs), white blood cells (WBCs), fibrin and platelets was performed using Orbit Image Software. A Wilcoxon test was used for continuous variables and χ 2 test for categorical variables. Results 1350 patients were included in this study. The overall rate of Thrombolysis In Cerebral Infarction (TICI) 2c/3 was 68%. 501 patients received tissue plasminogen activator (tPA) (37%). 267 patients (20%) had a large artery atherosclerosis (LAA) source, 662 (49%) a cardioembolic (CE) source, 301 (22%) were cryptogenic, and the remainder had other identifiable sources including hypercoagulable state or dissection. LAA thrombi had a higher mean RBC density (46±23% vs 42±22%, p=0.01) and a lower platelet density (24±18% vs 27±18%, p=0.03) than CE thrombi. Clots from dissection patients had the highest mean RBC density (50±24%) while clots from patients with a hypercoagulable state had the lowest mean RBC density (26±21%). Conclusions Our study found statistically significant but clinically insignificant differences between clots of CE and LAA etiologies. Future studies should emphasize molecular, proteomic and immunohistochemical characteristics to determine links between clot composition and etiology.

Original languageEnglish (US)
Pages (from-to)594-598
Number of pages5
JournalJournal of neurointerventional surgery
Issue number7
StatePublished - Jul 1 2021


  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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