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Histologic Characteristics of Intracranial Clots Retrieved Using Mechanical Thrombectomy

  • Woong YoonEmail author
Chapter

Abstract

A mechanical thrombectomy is currently the standard treatment for patients with acute ischemic stroke due to intracranial large-vessel occlusions [1–3]. The inclusion of a mechanical thrombectomy in stroke management allows the histologic examinations of retrieved clots occluding the intracranial arteries. A histologic analysis of a clot retrieved from an intracranial artery can provide important information on the stroke etiology, impacting secondary stroke prevention strategies. Intracranial clots are traditionally classified as red blood cell (RBC)-rich clots (red clots) or fibrin-rich clots (white clots). Therefore, this chapter covers the basic concepts of clots occluding human intracranial arteries in patients with acute ischemic stroke and presents recent evidence from histopathologic analyses of retrieved clots indicating an association between the clot composition and stroke etiology and imaging characteristics.

Keywords

Acute Ischemic Stroke Stroke Subtype Intracranial Artery Mechanical Thrombectomy Stroke Etiology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:3020–35.CrossRefPubMedGoogle Scholar
  2. 2.
    Badhiwala JH, Nassiri F, Alhazzani W, et al. Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA. 2015;314:1832–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Bush CK, Kurimella D, Cross LJ, et al. Endovascular treatment with stent-retriever devices for acute ischemic stroke: a meta-analysis of randomized controlled trials. PLoS One. 2016;11:e0147287.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Caplan LR. Anticoagulants to prevent stroke occurrence and worsening. Isr Med Assoc J. 2006;8:773–8.PubMedGoogle Scholar
  5. 5.
    Duffy S, Farrell M, McArdle K, et al. Novel methodology to replicate clot analogs with diverse composition in acute ischemic stroke. J Neurointerv Surg. 2016; doi: 10.1136/neurintsurg-2016-012308. [Epub ahead of print]Google Scholar
  6. 6.
    Kim SK, Yoon W, Kim TS, et al. Histologic analysis of retrieved clots in acute ischemic stroke: correlation with stroke etiology and gradient-echo MRI. AJNR Am J Neuroradiol. 2015;36:1756–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Niesten JM, van der Schaaf IC, van Dam L, et al. Histopathologic composition of cerebral thrombi of acute stroke patients is correlated with stroke subtype and thrombus attenuation. PLoS One. 2014;9:e88882.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Liebeskind DS, Sanossian N, Yong WH, et al. CT and MRI early vessel signs reflect clot composition in acute stroke. Stroke. 2011;42:1237–43.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Boeckh-Behrens T, Schubert M, Förschler A, et al. The impact of histological clot composition in embolic stroke. Clin Neuroradiol. 2016;26:189–97.CrossRefPubMedGoogle Scholar
  10. 10.
    Sato Y, Ishibashi-Ueda H, Iwakiri T, et al. Thrombus components in cardioembolic and atherothrombotic strokes. Thromb Res. 2012;130:278–80.CrossRefPubMedGoogle Scholar
  11. 11.
    Brinjikji W, Duffy S, Burrows A1, et al. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review. J Neurointerv Surg. 2016; doi: 10.1136/neurintsurg-2016-012391. [Epub ahead of print]Google Scholar
  12. 12.
    Simons N, Mitchell P, Dowling R, et al. Thrombus composition in acute ischemic stroke: a histopathological study of thrombus extracted by endovascular retrieval. J Neuroradiol. 2015;42:86–92.CrossRefPubMedGoogle Scholar
  13. 13.
    Kim SK, Yoon W, Heo TW, et al. Negative susceptibility vessel sign and underlying intracranial atherosclerotic stenosis in acute middle cerebral artery occlusion. AJNR Am J Neuroradiol. 2015;36:1266–71.CrossRefPubMedGoogle Scholar
  14. 14.
    Schuhmann MK, Gunreben I, Kleinschnitz C, et al. Immunohistochemical analysis of cerebral thrombi retrieved by mechanical thrombectomy from patients with acute ischemic stroke. Int J Mol Sci. 2016;17:298–308.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  1. 1.Department of RadiologyChonnam National University HospitalGwangjuSouth Korea

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