Histological composition of retrieved emboli in acute ischemic stroke is independent of pre-thrombectomy alteplase use

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

doi:10.1016/j.jstrokecerebrovasdis.2022.106376

Histological composition of retrieved emboli in acute ischemic stroke is independent of pre-thrombectomy alteplase use

J Stroke Cerebrovasc Dis. 2022 Apr;31(4):106376. doi: 10.1016/j.jstrokecerebrovasdis.2022.106376. Epub 2022 Feb 17.

Authors

Waleed Brinjikji¹, Mehdi Abbasi², Oana Madalina Mereuta³, Seán Fitzgerald³, Jorge Arturo Larco⁴, Daying Dai⁵, Ramanathan Kadirvel⁵, Raul G Nogueira⁶, Peter Kvamme⁷, Kennith F Layton⁸, Josser E Delgado⁹, Ricardo A Hanel¹⁰, Vitor M Pereira¹¹, Mohammed A Almekhlafi¹², Albert J Yoo¹³, Babak S Jahromi¹⁴, Matthew J Gounis¹⁵, Biraj M Patel¹⁶, Luis E Savastano², Harry J Cloft², Diogo C Haussen⁶, Alhamza Al-Bayati⁶, Mahmoud Mohammaden⁶, Leonardo Pisani⁶, Gabriel Rodrigues⁶, Ike C Thacker⁸, Yasha Kayan⁹, Alexander Z Copelan⁹, Amin Aghaebrahim¹⁰, Eric Sauvageau¹⁰, Andrew M Demchuk¹², Parita Bhuva¹³, Jazba Soomro¹³, Pouya Nazari¹⁴, Donald Robert Cantrell¹⁴, Ajit S Puri¹⁵, Karen M Doyle¹⁷, John Entwistle¹⁶, David F Kallmes²

Affiliations

¹ Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA. Electronic address: Brinjikji.Waleed@mayo.edu.
² Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
³ Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Physiology and CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
⁴ Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
⁵ Department of Radiology, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA.
⁷ Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA.
⁸ Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA.
⁹ NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
¹⁰ Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA.
¹¹ Departments of Medical Imaging and Surgery, Toronto Western Hospital, Toronto, Ontario, Canada.
¹² Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Alberta, Canada.
¹³ Department of Neurointervention, Texas Stroke Institute, Plano, Texas, USA.
¹⁴ Departments of Radiology and Neurosurgery, Northwestern University, Chicago, IL, USA.
¹⁵ Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA.
¹⁶ Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, VA, USA.
¹⁷ Department of Physiology and CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.

PMID: 35183984
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106376

Abstract

Background and purpose: Given recent evidence suggesting the clot composition may be associated with revascularization outcomes and stroke etiology, clot composition research has been a topic of growing interest. It is currently unclear what effect, if any, pre-thrombectomy thrombolysis has on clot composition. Understanding this association is important as it is a potential confounding variable in clot composition research. We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients who did and did not receive pre-treatment tPA to study the effect of tPA on clot composition.

Materials and 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 Scarlett Blue (MSB) staining and area of the clot was also measured on the gross photos. Student's t test was used for continuous variables and chi-squared test for categorical variables.

Results: A total of 1430 patients were included in this study. Mean age was 68.4±13.5 years. Overall rate of TICI 2c/3 was 67%. A total of 517 patients received tPA (36%) and 913 patients did not (64%). Mean RBC density for the tPA group was 42.97±22.62% compared to 42.80±23.18% for the non-tPA group (P=0.89). Mean WBC density for the tPA group was 3.74±2.60% compared to 3.42±2.21% for the non-tPA group (P=0.012). Mean fibrin density for the tPA group was 26.52±15.81% compared to 26.53±15.34% for the non-tPA group (P=0.98). Mean platelet density for the tPA group was 26.22±18.60% compared to 26.55±19.47% for the non-tPA group (P=0.75). tPA group also had significantly smaller clot area compared to non-tPA group.

Conclusions: Our study 1430 retrieved emboli and ischemic stroke patients shows no interaction between tPA administration and clot composition. These findings suggest that tPA does not result in any histological changes in clot composition.

Keywords: Clot composition; Stroke; Thrombectomy; r-TPA.

MeSH terms

Aged
Aged, 80 and over
Brain Ischemia* / diagnostic imaging
Brain Ischemia* / drug therapy
Humans
Ischemic Stroke* / diagnosis
Ischemic Stroke* / drug therapy
Middle Aged
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / drug therapy
Thrombectomy / adverse effects
Tissue Plasminogen Activator / adverse effects

Substances

Tissue Plasminogen Activator

Grants and funding

R01 NS105853/NS/NINDS NIH HHS/United States