Histologic differences between in situ and embolized carotid web thrombi: a case report

Abstract Background The significance of carotid webs (CaWs) in ischemic stroke is becoming acknowledged. Histological features of clot composition in situ and secondary cerebrovascular embolized thrombi caused by CaW have not been described concurrently. Understanding clots’ histological composition is essential for understanding the pathophysiology of clot formation in CaW. Case presentation A 50-year-old male patient with acute ischemic stroke, which was believed to be caused by ipsilateral CaW, was admitted to the hospital. Mechanical thrombectomy was used to retrieve thromboemboli from the middle cerebral artery. One month thereafter, the patient underwent carotid endarterectomy, and in situ CaW thrombi were retrieved. Histological analysis by hematoxylin and eosin staining revealed that histopathologic embolized thrombi appeared as typical mixed thrombi, 46.03% fibrin/platelet ratio, 48.12% RBCs, and 5.85% white blood cells. In situ thrombi had a higher fibrin/platelet ratio (68.0%), fewer RBCs (17.2%), and 14.8% white blood cells. Conclusion The histopathology of large vessel occlusion stroke embolized thrombi by CaW is similar to that of other stroke etiologies. However, the clot composition of embolized thrombi significantly differs from that of in situ thrombi. CaW’s in situ thrombi showed predominantly fibrin, and embolized thrombi had equivalent contents of red blood cells and fibrin/platelets. Histopathological differences between in situ and embolized thrombi suggest new research directions for the etiology of embolization. Further studies are required to confirm these results.

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Clot composition in retrieved thrombi after mechanical thrombectomy in strokes due to carotid web

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017112 ◽

2021 ◽

pp. neurintsurg-2020-017112

Author(s):

Sitara Koneru ◽

Raul G Nogueira ◽

Ehizele Osehobo ◽

Gabriela Oprea-Ilies ◽

Alhamza R Al-Bayati ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Cells ◽

Mechanical Thrombectomy ◽

White Blood Cells ◽

Case Series ◽

Composition Analysis ◽

Conventional Angiography ◽

Vessel Occlusion ◽

Ct Angiogram ◽

Staining Techniques

BackgroundThe association of carotid webs (CaW) and ischemic stroke is being increasingly recognized. Data on the histologic clot architecture in strokes caused by CaW has not been previously described. Understanding thrombi histopathology may provide insight into the pathophysiology of CaW-related strokes.MethodsThis case series presents three patients with acute ischemic stroke thought to be caused by ipsilateral CaW. Thromboemboli were retrieved from the middle cerebral artery (MCA) by mechanical thrombectomy and histologic analysis was performed.ResultsThree patients aged between 41 and 55 years with few to no vascular risk factors presented with symptoms concerning for an acute MCA territory infarction (National Institutes of Health Stroke Scale (NIHSS) range 10–17). Non-contrast computed tomography (CT) Alberta Stroke Program Early CT Score (ASPECTS) range was 7–8 and all patients had hyperdense vessel sign. Initial CT angiogram was concerning for CaW with no superimposed thrombus, later confirmed with conventional angiography. All patients underwent thrombectomy with full reperfusion. Comprehensive stroke workup failed to reveal other etiologies besides ipsilateral CaW. The histopathologic appearance was of typical fresh mixed thrombi. Qualitative thrombus composition analysis of clot from Case #1 yielded 42.5% fibrin, 50.0% red blood cells (RBC), and 7.5% white blood cells (WBC); Case #2 yielded 46.9% fibrin, 43.4% RBC, and 9.7% WBC; and Case #3 yielded 61.5% fibrin, 31.8% RBC, and 6.7% WBC.ConclusionsThe clot composition of large vessel occlusion strokes from CaW is comparable to the histopathology of previously reported clots from other stroke etiologies. Advanced staining techniques may aid in further characterizing the thrombi of this poorly understood condition.

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Correlation of Neutrophil to Lymphocyte Ratio with Expression of Neutrophil Extracellular Traps Within Stroke Emboli

Interventional Neuroradiology ◽

10.1177/15910199211065530 ◽

2021 ◽

pp. 159101992110655

Author(s):

Jorge Arturo Larco ◽

Mehdi Abbasi ◽

Sarosh Irfan Madhani ◽

Madalina Oana Mereuta ◽

Yang Liu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Cells ◽

White Blood Cells ◽

Neutrophil Extracellular Traps ◽

Vessel Occlusion ◽

Average Percentage ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Extracellular Traps

Background & Purpose It has been hypothesized that circulating neutrophils have a direct correlation with the composition of emboli in acute ischemic stroke (AIS). The aim of this study is to evaluate the association between neutrophil-lymphocyte ratio (NLR) in peripheral blood and the expression of neutrophil extracellular traps (NETs) within stroke emboli. Methods Consecutive patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) that underwent mechanical thrombectomy (MT) were included. Patients were divided into two groups based on NLR median value. Retrieved thrombi were histologically analyzed using Martius Scarlett Blue (MSB) for main thrombus components including red blood cells (RBCs), white blood cells (WBCs), fibrin and platelet. Immunohistochemistry staining for von Willebrand Factor (vWF) and anti-citrullinated H3 (H3Cit; NETs marker) was also performed. Results Samples from a total of 84 patients were included. The average percentage of RBCs, WBCs, fibrin, platelet, H3Cit, and vWF components in thrombi were 45.1%, 3.5%, 21.8%, 29.6%, 19.7% and 14.8% respectively. When stratifying by NLR group [low (≤3.94) versus high (>3.95)], high NLR group had significantly more WBCs (4.5%), fibrin (24.2%), H3Cit (22.7%) and vWF (17.1%) thrombus fractions compared to low NLR group. Additionally, RBC content (38.8%) was lower in the high NLR group. Conclusions NLR is correlated with the amounts of WBCs, fibrin, NETs and vWF within the thrombi retrieved from AIS patients due to LVO.

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Heterogeneity between proximal and distal aspects of occlusive thrombi on pretreatment imaging in acute ischemic stroke

The Neuroradiology Journal ◽

10.1177/19714009211049713 ◽

2021 ◽

pp. 197140092110497

Author(s):

Tetsuya Hashimoto ◽

Takenobu Kunieda ◽

Tristan Honda ◽

Fabien Scalzo ◽

Latisha K Sharma ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Region Of Interest ◽

Hounsfield Unit ◽

Distal Segment ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

The Difference

Background The potential heterogeneity in occlusive thrombi caused by in situ propagation by secondary thrombosis after embolic occlusion could obscure the characteristics of original thrombi, preventing the clarification of a specific thrombus signature for the etiology of ischemic stroke. We aimed to investigate the heterogeneity of occlusive thrombi by pretreatment imaging. Methods Among consecutive stroke patients with acute embolic anterior circulation large vessel occlusion treated with thrombectomy, we retrospectively reviewed 104 patients with visible occlusive thrombi on pretreatment non-contrast computed tomography admitted from January 2015 to December 2018. A region of interest was set on the whole thrombus on non-contrast computed tomography under the guidance of computed tomography angiography. The region of interest was divided equally into the proximal and distal segments and the difference in Hounsfield unit densities between the two segments was calculated. Results Hounsfield unit density in the proximal segment was higher than that in the distal segment (mean difference 4.45; p < 0.001), regardless of stroke subtypes. On multivariate analysis, thrombus length was positively correlated (β = 0.25; p < 0.001) and time from last-known-well to imaging was inversely correlated (β = −0.0041; p = 0.002) with the difference in Hounsfield unit densities between the proximal and distal segments. Conclusions The difference in density between the proximal and distal segments increased as thrombi became longer and decreased as thrombi became older after embolic occlusion. This time/length-dependent thrombus heterogeneity between the two segments is suggestive of secondary thrombosis initially occurring on the proximal side of the occlusion.

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Activity of different subtypes of superoxide dismutase in acute period of ischemic stroke

Bukovinian Medical Herald ◽

10.24061/2413-0737.xviii.4.72.2014.215 ◽

2014 ◽

Vol 18 (4 (72)) ◽

Author(s):

N. R. Sokhor ◽

S. I. Shkrobot ◽

O. Y. Budarna ◽

A. M. Musiienko

Keyword(s):

Reactive Oxygen Species ◽

Superoxide Dismutase ◽

Ischemic Stroke ◽

Infarct Size ◽

Blood Cells ◽

White Blood Cells ◽

Intracellular Reactive Oxygen Species ◽

Oxygen Species ◽

Acute Period ◽

Reliable Correlation

86 patients in the acute period of ischemic stroke (IS) were involved in a study of the activity of general SOD, intracellular (Cu,Zn-SOD), mitochondrial (Mn-SOD2) and numbers of white blood cells with a high content of intracellular reactive oxygen species (ROS+-cells). A reduction of activity of general SOD, Cu,Zn-СОД, Mn-SOD and increase of ROS+-cells number were detected. There was a reliable negative correlation between activity of general SOD, Mn-SOD and the number of ROS+-cells on the 1st day of IS. It was established that the activity of the general SOD, Cu,Zn-СОД, Mn-SOD and number of ROS+-cells depend on the severity of the IS and the infarct size. Credible negative correlations were found at the moderate and severe IS and infarct size 10-100 cm2. A direct reliable correlation between the content of ROS+-cells and degree of the severity and size of the IS were observed.

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The nature of leukocyte shape changes in the pulmonary capillaries

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.1997.273.4.l733 ◽

1997 ◽

Vol 273 (4) ◽

pp. L733-L740 ◽

Cited By ~ 4

Author(s):

Darlene M. Redenbach ◽

Dean English ◽

James C. Hogg

Keyword(s):

Blood Cells ◽

White Blood Cells ◽

Cell Polarization ◽

Cell Counts ◽

Pulmonary Capillaries ◽

Size Discrepancy ◽

Capillary Bed ◽

Washout Curves ◽

Shape Changes

The size discrepancy between leukocytes [white blood cells (WBCs)] and pulmonary capillaries requires WBCs to deform. We investigated the persistence of this deformation on cells leaving the capillary bed and the role played by the cytoskeleton. Isolated rabbit lungs were perfused in situ via the pulmonary artery with effluent fractions collected from the left ventricle. Washout curves from cell counts in each fraction confirmed that WBCs are preferentially retained over erythrocytes. WBC deformation present on exit from the circulation was compared with that present after recovery in paired fractions, fixed either immediately or 60 min later. These cells were compared with cells recovered from the capillary in perfused fixative or fixed in peripheral blood. Our results show that leukocyte deformation persisted after the cells exited the pulmonary circulation. This deformation was associated with minimal submembranous F-actin staining, and microtubule distribution and cell polarization were unchanged. We conclude that cytoskeletal changes that occur during WBC deformation in the pulmonary capillaries are minimal and differ from those known to occur in actively migrating cells during chemotaxis.

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Abstract WP43: Anti-Coagulation Therapy Prior to Mechanical Thrombectomy is Associated With Reduced Procedure Time and Low Proportion of Fibrin in Retrieved Thrombus

Stroke ◽

10.1161/str.51.suppl_1.wp43 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kota Maekawa ◽

Kobayashi Kazuto ◽

Sano Takanori ◽

Shibata Masunari ◽

Yabana Tadashi ◽

...

Keyword(s):

Blood Cells ◽

Mechanical Thrombectomy ◽

White Blood Cells ◽

Recombinant Tissue Plasminogen Activator ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Procedure Time ◽

Vessel Occlusion ◽

Coagulation Therapy

Introduction: Very few studies have investigated the relationship between the histopathology of the retrieved thrombus by mechanical thrombectomy for large vessel occlusion and anti-coagulation agents before mechanical thrombectomy. A study in vitro showed that clots of patients with anti-coagulation agents were dissolved easily compared to those of patients with aspirin. Hypothesis: Anti-coagulation therapy prior to mechanical thrombectomy is associated with reduced procedure time and low proportion of fibrin in retrieved thrombus. Methods: All retrieved thrombus was stained with hematoxylin-eosin. Embolic debris underwent quantitative analysis to quantify three main components: red blood cells, white blood cells and fibrin, by color based segmentation. Patients were assingned to receive either mechanical thrombectomy with anti-coagulation agents (AC-MT group) or mechanical thrombectomy alone (MT group). Considering influence by stroke etiology, patients with non-cardioembolism were excluded. Results: From August 2015 to Dec 2018, 226 consecutive patients were treated in our hospital by MT for acute large vessel occlusion. Histopathologic analysis of retrieved thrombus from 119 patients with acute stroke. 92 patients with cardioembolism were included. Patients were assigned to AC-MT group (n=35) or MT group (n=57). Clinical backgrounds were not significantly different. PT-INR was higher in AC-MT group. (1.32 vs 1.06; p<0.01) The proportion of patients with recombinant tissue plasminogen activator was not significantly different (26% vs 43%; p=0.12). AC-MT group had shorter puncture to recanalization time (median 38 vs 54 minutes; p<0.01) and tendency to reduce number of maneuvers [median 2 (range 1-4) vs 2 (range 1-6); p=0.06]. AC-MT group had lower proportion of fibrin in retrieved thrombus (44.3% vs 77.3%, p<0.01). Conclusion: Anti-coagulation therapy prior to mechanical thrombectomy is associated with reduced procedure time and low proportion of fibrin in retrieved thrombus.

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Abstract WP31: Fibrin Rich Thrombus versus Erythrocyte Rich Thrombus in Acute Large Vessel Occlusion

Stroke ◽

10.1161/str.48.suppl_1.wp31 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kota Maekawa ◽

Masunari Shibata ◽

Masaru Seguchi ◽

Kazuto Kobayashi ◽

Hidetaka Nakajima ◽

...

Keyword(s):

Blood Cells ◽

Mechanical Thrombectomy ◽

Clinical Laboratory ◽

White Blood Cells ◽

Functional Independence ◽

Large Vessel ◽

Basilar Artery Occlusion ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Significant Difference

Objective: The aim of this study was to evaluate thrombus composition and its association with clinical, laboratory, and neurointerventional findings in patients treated by mechanical thrombectomy due to acute large vessel occlusion. Methods: From August 2015 to June 2016, 72 patients were treated in our hospital by mechanical thrombectomy using stent retriever and/or aspiration catheter. Retrieved thrombi underwent semiquantitative analysis to quantify red blood cells, white blood cells, and fibrin by area. We divided patients into two groups as fibrin rich group or erythrocyte rich group according to predominant composition in thrombus. Two groups were compared with respect to imaging, clinical, and neurointerventional data. Results: Histopathologic analysis of retrieved thrombus from 37 patients with acute stroke due to internal carotid artery, middle cerebral artery, or basilar artery occlusion was performed. Erythrocyte rich thrombi were present in 13 (35%) of cases, and fibrin rich thrombi in 24 (65%). Cardioembolic etiology was significantly more in patients with fibrin rich thrombi than those with erythrocyte rich thrombi (79% vs. 38%; p=0.01). All other clinical and laboratory characteristics did not differ. Patients with fibrin rich thrombi had greater number of recanalization maneuvers (2.8 ± 1.2 vs. 1.8 ± 1.6, p=0.04) and longer interval time between puncture and recanalization (62 ± 33.6 minutes vs. 42 ± 21.3 minutes; p=0.04). There is no significant difference in occluded vessels and mechanical thrombectomy devices between two groups. Patients with fibrin rich thrombi were lower rate of functional independence (mRS score, 0-2) at 90 days (33% vs. 75%; p=0.04). Conclusion: This study showed that fibirin rich thrombus was associated with extended procedure time, unfavorable clinical outcome and cardioembolic etiology.

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Atypical cells in sysmex UN automated urine particle analyzer: a case report and pitfalls for future studies

Turkish Journal of Biochemistry ◽

10.1515/tjb-2019-0418 ◽

2020 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Ozgur Aydin ◽

Onur Yapıcı ◽

Ruksan Copuroglu

Keyword(s):

Case Report ◽

Blood Cells ◽

White Blood Cells ◽

Pathology Report ◽

Case Presentation ◽

Future Studies ◽

Atypical Cells ◽

Papillary Lesions ◽

Automated Instrument

AbstractObjectivesSysmex UN series fully automated urine analyzer reports a series of research parameters besides routine parameters including the “atypical cells” parameter. An automated instrument in clinical use capable of detecting neoplastic cells of the urinary tract will have paramount significance.Case presentationA 73 years old male patient with a recurrent high grade urothelial carcinoma admitted to our urology outpatient clinic due to hematuria.Urinalysis showed +3 hemoglobin, +3 leukocyte esterase, 200/HPF red blood cells, 300/HPF white blood cells. The instrument also reported atypical cells (7.6/µL or 1.3/HPF) under the heading of “research parameters.” Presence of atypical cells was confirmed by the manual microscopy. The patient has undergone transurethral resection of papillary lesions and the pathology report confirmed a recurrence. On follow-up, atypical cells fell to 0.1/µL after 40 days.ConclusionsThis case report presents a patient with atypical cells in urine, detected by a fully automated urine analyzer. The atypical cells presented on the screen of the analyzer were confirmed by the manual microscopy. This presentation may influence future studies pertaining to the subject.

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Development and reliability of the histological THROMBEX-classification rule for thrombotic emboli of acute ischemic stroke patients

Neurological Research and Practice ◽

10.1186/s42466-021-00149-6 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Julika Ribbat-Idel ◽

Florian Stellmacher ◽

Florian Jann ◽

Nicolas Kalms ◽

Inke R. König ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Diagnostic Tool ◽

Interobserver Reliability ◽

Classification Rule ◽

Stroke Patients ◽

New Classification ◽

Vessel Occlusion ◽

Hematoxylin And Eosin

Abstract Background Thrombus histology has become a potential diagnostic tool for the etiology assessment of patients with ischemic stroke caused by embolic proximal vessel occlusion. We validated a classification rule that differentiates between cardiac and arteriosclerotic emboli in individual stroke patients. We aim to describe in detail the development of this classification rule and disclose its reliability. Methods The classification rule is based on the hypothesis that cardiac emboli arise out of separation thrombi and arteriosclerotic emboli result from agglutinative thrombi. 125 emboli recovered by thrombectomy from stroke patients and 11 thrombi serving as references for cardiac (n = 5) and arteriosclerotic emboli (n = 6) were Hematoxylin and eosin, Elastica-van Gieson and CD61 stained and rated independently by two histopathologists blinded to the presumed etiology by several pre-defined criteria. Intra- and interobserver reliabilities of all criteria were determined. Out of the different criteria, three criteria with the most satisfactory reliability values were selected to compose the classification rule that was finally adjusted to the reference thrombi. Reliabilities of the classification rule were calculated by using the emboli of stroke patients. Results The classification rule reached intraobserver reliabilities for the two raters of 92.9% and 68.2%, respectively. Interobserver reliability was 69.9%. Conclusions A new classification rule for emboli obtained from thrombectomy was established. Within the limitations of histological investigations, it is reliable and able to distinguish between cardioembolic and arteriosclerotic emboli.

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Knowledge and Perception of Cord Blood Bank among Lebanese Population

World Journal of Social Science Research ◽

10.22158/wjssr.v3n3p307 ◽

2016 ◽

Vol 3 (3) ◽

pp. 307

Author(s):

Bassam Charif Hamdar ◽

Rita Abla

Keyword(s):

Stem Cells ◽

Cord Blood ◽

Blood Cells ◽

Arab World ◽

Genetic Diseases ◽

White Blood Cells ◽

Blood Disorders ◽

Blood Stem Cells ◽

Cord Blood Cells ◽

New Research

The cord blood cells are hematopoietic stem cells which can differentiate only into blood cells. In other words, cord blood stem cells are blood cell precursors which can form red blood cells, white blood cells, and platelets. Nowadays, these cells are being used to treat blood and immune system that associated with genetic diseases, cancers, and blood disorders.Due to the great value of the stem cells, new research and technology show that it is highly recommended that cord blood cells are reserved for the future use. This paper will shed light on the important aspects and the ability of doing blood cord bank in Lebanon.This paper is exploratory in nature and its mere purpose is to focus on some aspects that were first not known in the Arab world in general and in Lebanon in specific. To achieve all the above, a questionnaire has been designed and delivered to the sample via different means.An overview of this paper reveals some understanding about the level of awareness achieved by the Lebanese citizens. Other objectives came into play and some of those were the relation between banking cord blood and religion.The outcome of this paper is a practicability study of blood cord bank which is related two concepts, with and against, by revealing the pros and cons of this subject.

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