Platelet-rich clots as identified by Martius Scarlet Blue staining are isodense on NCCT

Fitzgerald, Seán; Wang, Shunli; Dai, Daying; Douglas, Andrew; Kadirvel, Ramanathan; Gounis, Matthew J.; Chueh, Juyu; Puri, Ajit S; Layton, Kennith F.; Thacker, Ike; Hanel, Ricardó A.; Sauvageau, Eric; Aghaebrahim, Amin; Almekhlafi, Mohammed; Demchuk, Andrew M.; Nogueira, Raul G; Pereira, Vítor Mendes; Kvamme, Peter; Kayan, Yasha; Almandoz, Josser E Delgado; Yoo, Albert J.; Kallmes, David F.; Doyle, Karen M.; Brinjikji, Waleed

doi:10.1136/neurintsurg-2018-014637

Cited by 51 publications

(72 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a previous study we demonstrated that platelet-rich clots, as identified using the MSB stain, are isodense on NCCT [20]. In that study, we quantified red blood cells, white blood cells, Fibrin and Platelets/Other.…”

Section: Discussionmentioning

confidence: 94%

Platelet-rich emboli are associated with von Willebrand factor levels and have poorer revascularization outcomes

Douglas

Fitzgerald

Mereuta

et al. 2019

J NeuroIntervent Surg

Self Cite

View full text Add to dashboard Cite

Background and aimsPlatelets and von Willebrand factor (vWF) are key factors in thrombosis and thus are likely key components of acute ischemic stroke (AIS) emboli. We aimed to characterize platelet and vWF levels in AIS emboli and to assess associations between their expression levels and clinical and procedural information.Materials and methodHistopathological and immunohistochemical analysis of emboli collected as part of the multi-institutional RESTORE registry was performed. The composition of the emboli was quantified using Orbit Image Analysis machine learning software. Correlations between clot components and clinical and procedural information were assessed using the χ2 test.ResultsNinety-one emboli samples retrieved from 63 patients were analyzed in the study. The mean platelet (CD42b) content of the clots was 33.9% and the mean vWF content of the clots was 29.8%. There was a positive correlation between platelet and vWF levels (ρ=0.564, p<0.001*, n=91). There was an inverse correlation between both platelets and vWF levels and percentage of red blood cells (RBCs) in the emboli (CD42b vs RBC: ρ=−0.535, p<0.001*, n=91; vWF vs RBC: ρ=−0.366, p<0.001*, n=91). Eighty-one percent of patients in the low platelet group had a good revascularization outcome (Thrombolysis in Cerebral Infarction 2c/3) compared with 58% in the high platelet group (χ2=5.856, p=0.016).ConclusionPlatelet and vWF levels in AIS emboli correlate with each other and both have an inverse relationship with RBC composition. Patients with platelet-rich clots have poorer revascularization outcomes.

show abstract

Section: Discussionmentioning

confidence: 94%

Platelet-rich emboli are associated with von Willebrand factor levels and have poorer revascularization outcomes

Douglas

Fitzgerald

Mereuta

et al. 2019

J NeuroIntervent Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Indeed, although other factors are involved in the achievement of a favorable clinical outcome, such as good collaterals5 and shorter time to reperfusion (TTR),6 an adequate recanalization grade remains an independent predictor of functional independence7–9 although futile recanalizations are still observed. Some authors have proposed different predictors of recanalization according to the clot imaging characteristics, such as the susceptibility vessel sign on MRI10 and attenuation on CT scan,11 as well as the thrombus length12 and the clot burden score 13. In this paper we aim to assess the recanalization rate obtained with SR or CA according to the phenotype of the occlusion site, defined as ‘regular’ and ‘irregular’ (see online supplemental figure 1) in a cohort of patients with a M1-middle cerebral artery (M1-MCA) occlusion included in the ASTER trial.…”

Section: Introductionmentioning

confidence: 99%

Effect of the phenotype of the M1-middle cerebral artery occlusion on the recanalization rates in the ASTER trial

Consoli

Zhu

Bourcier

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

IntroductionAn adequate recanalization grade is an independent predictor of a good clinical outcome in patients with acute ischemic stroke. It can be obtained with stent retrievers (SR) and contact aspiration (CA). The aim of this ancillary study of the ASTER trial was to investigate the effect of the regular and irregular phenotype of the M1-middle cerebral artery (M1-MCA) segment occlusion on the procedural and clinical outcomes in the ASTER trial population.MethodsThe predetermined occlusion phenotype assessment was performed by the core laboratory of the ASTER trial and patients with M1-MCA occlusion were included in this study. Clinical and procedural outcomes were analyzed according to the technique used and to the occlusion phenotype.Results188 patients were included in the analysis (95 received SR, 93 CA as first-line treatment). The occlusion phenotypes were graded as irregular in 52.7% of cases (n=99, 95% CI 45.5% to 59.8%). In patients with an irregular occlusion phenotype, complete or adequate recanalization at the end of the first-line strategy was more often achieved with SR than CA (TICI 3: SR 44.1% vs CA 22.5%, OR 0.35, 95% CI 0.14 to 0.89, p=0.027), with a shorter procedure time, a lower number of passes (>2 passes: SR 32.2% vs CA 57.5%, OR 3.31, 95% CI 1.36 to 8.03, p=0.009), and higher rates of favorable clinical outcome (SR 55.2% vs CA 31.6%, OR 0.40, 95% CI 0.16 to 0.97, p=0.042).ConclusionIrregular M1-MCA occlusion phenotypes treated with SR as first-line approach were associated with better procedural and clinical outcomes in the ASTER trial population

show abstract

“…[5,6,19] A recent study has demonstrated that platelet-rich thrombi identi ed by MSB staining are isodense on NCCT. [10] We found that 'white' thrombi are smaller and less hyperdense compared to the other clots.…”

Section: Discussionmentioning

confidence: 58%

“…We used the MSB stain which allows for a signi cantly better differentiation of the major components of clots than the traditional hematoxylin & eosin stain. [10] 'White' clots were platelet-rich compared to 'red' thrombi. We con rmed the presence of calci cation in one case using von Kossa stain.…”

Section: Discussionmentioning

confidence: 99%

“…1). The clots were para n-embedded, sectioned and stained with Martius Scarlett Blue (MSB) to identify main components [10], von Kossa and Alizarin Red stainings to con rm calci cation and mineralization when suspected and immunostained for platelets (rabbit monoclonal anti-CD42b, Abcam ab227669), von Willebrand Factor (monoclonal mouse anti-human vWF, Dako M0616) and fatty-acid binding protein 4 (anti-FABP4 rabbit polyclonal, Abcam ab13979) for adipocytes.…”

Section: Clot Analysismentioning

confidence: 99%

See 1 more Smart Citation

Characterization of the ‘White’ Appearing Clots that Cause Acute Ischemic Stroke

Mereuta

Fitzgerald

Rossi

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Most clots retrieved from patients with acute ischemic stroke are ‘red’ in color and are predominantly composed of red blood cells and fibrin. ‘White’ clots represent a less common entity and their histological composition is largely unknown.The aim of this study was to investigate the composition, imaging and procedural characteristics of ‘white’ clots retrieved by mechanical thrombectomy.Materials and Methods:Nineteen ‘white’ thrombi selected by visual inspection from 293 cases were collected as part of the multi-institutional RESTORE registry. Non-contrast computed tomography (NCCT), histological and immunohistochemical analyses were performed. Components were quantified using Orbit Image Analysis.Results:Quantification of Martius Scarlett Blue stain identified platelets/other as the major component in ‘white’ clots’ (63%) followed by fibrin (26%), red blood cells (7%) and white blood cells (4%). ‘White’ clots presented significantly more platelets/other and less red blood cells compared to the ‘red’ clots which showed a mean of 23% and 44%, respectively. The mean platelet (CD42b) content in ‘white’ clots was 43%; von Willebrand Factor (vWF) mean expression was 38%.Collagen and calcification were associated in one case. Fatty acid binding protein 4 was expressed in two cases.‘White’ clots were also significantly smaller (9.5 versus 12 mm) and less hyperdense (52 versus 61 Hounsfield Units) on NCCT compared to the other cases.Conclusions:‘White’ clots represented 6% of our cohort and are platelet and vWF-rich. Calcification, collagen and adipocytes were found occasionally. ‘White’ clots differ from other clots in composition, size and density on NCCT.

show abstract

Platelet-rich clots as identified by Martius Scarlet Blue staining are isodense on NCCT

Cited by 51 publications

References 20 publications

Platelet-rich emboli are associated with von Willebrand factor levels and have poorer revascularization outcomes

Platelet-rich emboli are associated with von Willebrand factor levels and have poorer revascularization outcomes

Effect of the phenotype of the M1-middle cerebral artery occlusion on the recanalization rates in the ASTER trial

Characterization of the ‘White’ Appearing Clots that Cause Acute Ischemic Stroke

Contact Info

Product

Resources

About