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Dai D, Bilgin C, Ding Y, Ghozy S, Mereuta OM, Kallmes DF, Kadirvel R. How the elastase-induced rabbit aneurysm heals following flow diverter treatment: a histopathological study. J Neurosurg 2024:1-8. [PMID: 38759235 DOI: 10.3171/2024.2.jns232262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/22/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE Fibrin deposition is integral to thrombus formation and wound healing. The role of fibrin deposition and subsequent metabolism following flow diversion for aneurysm treatment remains poorly characterized. This study aimed to evaluate the role of fibrin in early thrombus organization after flow diverter treatment. METHODS Thirty-five elastase-induced aneurysms were induced in New Zealand white rabbits and subjected to endoluminal flow diversion treatment. The device-bearing arteries were harvested at 1, 3, and 6 months postimplantation and processed for histopathological examination, including a modified picro-Mallory stain (Carstairs method) to visualize fibrin and platelets, immunohistochemical targeting of smooth muscle actin (SMA), and H&E staining for conventional morphological evaluation. Quantitative analysis of tissue components was carried out using the Orbit Image Analysis software. The samples were also assessed qualitatively to investigate the morphology and location of fibrin and other thrombus components within the intra-aneurysmal thrombi. Statistical analyses were conducted using R software version 4.3.1. RESULTS Fibrin constituted 27.9% of the thrombus tissue within the aneurysm sac for aneurysms harvested at 1 month, and this rate was significantly lower in the 3-month group (10.2%, p = 0.018). The proportion of blood cells within the sac was also notably higher in the 1-month group compared with other time points. The primary tissue filling the dome at 1 month (14/15, 93%) was an unorganized thrombus primarily composed of fibrin, platelets, and red blood cells. Conversely, aneurysms harvested at 1 month had the lowest collagen level (25.6%). However, collagen became the dominant tissue component within the aneurysm sac, accounting for 71.8% of tissue in the 3-month group (p = 0.007). There were no differences observed among the examined components between the 3-month and 6-month groups. On qualitative analysis, collagen-producing SMA-positive myofibroblasts were located near or in between fibrin molecules. Healed aneurysms exhibited myofibroblasts, collagen, and a well-organized fibrin network on the aneurysm neck. In contrast, unhealed aneurysms displayed a poorly organized fibrin network with scattered myofibroblasts at the neck area. CONCLUSIONS These findings indicate that fibrin plays a foundational role in the gradual occlusion of aneurysms after flow diverter treatment. Endovascular approaches that enhance fibrin accumulation could potentially improve aneurysm occlusion rates. Further research is needed to establish the precise role of fibrin in aneurysm occlusion.
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Affiliation(s)
| | | | | | - Sherief Ghozy
- Departments of1Radiology and
- 2Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Ramanathan Kadirvel
- Departments of1Radiology and
- 2Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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2
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Janot K, Boulouis G, Forestier G, Bala F, Cortese J, Szatmáry Z, Bardet SM, Baudouin M, Perrin ML, Mounier J, Couquet C, Yardin C, Segonds G, Dubois N, Martinez A, Lesage PL, Ding YH, Kadirvel R, Dai D, Mounayer C, Terro F, Rouchaud A. WEB shape modifications: angiography-histopathology correlations in rabbits. J Neurointerv Surg 2024; 16:302-307. [PMID: 37192788 DOI: 10.1136/jnis-2023-020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND WEB Shape Modification (WSM) over time is frequent after aneurysm treatment. In this study, we explored the relationship between histopathological changes and angiographic evolution over time in experimental aneurysms in rabbits treated with the Woven EndoBridge (WEB) procedure. METHODS Quantitative WSM was assessed using flat-panel computed tomography (FPCT) during follow-up by calculating height and width ratio (HR, WR), defined as the ratio between either measurement at an index time point and the measurement immediately after WEB implantation. The index time point varied from 1 day to 6 months. HR and WR were evaluated with angiographic and histopathological assessments of aneurysm healing. RESULTS Final HR of devices varied from 0.30 to 1.02 and final WR varied from 0.62 to 1.59. Altogether, at least 5% of HR and WR variations were observed in 37/40 (92.5%) and 28/40 (70%) WEB devices, respectively, at the time of final assessment. There was no significant correlation between complete or incomplete occlusion groups and HR or WR (p=0.15 and p=0.43). Histopathological analysis revealed a significant association between WR and aneurysm healing and fibrosis 1 month following aneurysm treatment (both p<0.05). CONCLUSION Using longitudinal FPCT assessment, we observed that WSM affects both the height and width of the WEB device. No significant association was found between WSM and aneurysm occlusion status. Although presumably a multifactorial phenomenon, the histopathological analysis highlighted a significant association between width variations, aneurysm healing and fibrosis in the first month following aneurysm treatment.
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Affiliation(s)
- Kevin Janot
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Grégoire Boulouis
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Géraud Forestier
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Fouzi Bala
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Jonathan Cortese
- NEURI The Brain Vascular Center, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | | | | | | | | | - Jérémy Mounier
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | - Claude Couquet
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | - Catherine Yardin
- Histology, Cytology, Cellular Biology and Cytogenetics, University Hospital of Limoges, Limoges, France
| | | | | | | | | | | | | | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Charbel Mounayer
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Faraj Terro
- Cell Biology, University Hospital of Limoges, Limoges, France
| | - Aymeric Rouchaud
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
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Bilgin C, Dai D, Johnson C, Mereuta OM, Kallmes DF, Brinjikji W, Kadirvel R. Quality assessment of histopathological stainings on prolonged formalin fixed thrombus tissues retrieved by mechanical thrombectomy. Front Neurol 2023; 14:1223947. [PMID: 38152640 PMCID: PMC10751908 DOI: 10.3389/fneur.2023.1223947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/03/2023] [Indexed: 12/29/2023] Open
Abstract
Background Formalin-fixed retrieved clots from mechanical thrombectomy (MT) are now routinely studied using both conventional histopathologic techniques and immunohistochemistry (IHC). However, the effects of prolonged formalin fixation on the histological results of clot analysis remain unknown. The objective of this study was to investigate the effects of prolonged formalin fixation on quality of histopathologic stainings of thrombus tissues retrieved by MT. Methods As part of the multicenter EXCELLENT registry, a total of 80 clots extracted by MT from acute ischemic stroke patients were randomly selected from the tissue database and assigned into four groups according to 10% neutral buffered formalin (NBF) fixation duration (1-30, 30-60, 60-90, and 90+ days, up to 2 years). Samples underwent processing and sectioning. Two serial sections for each case were stained with hematoxylin and eosin (H&E), Martius Scarlet Blue (MSB), and IHC for CD42b (platelet marker). An expert pathologist, who was blinded to tissue fixation duration and patient clinical data, assessed the quality of each stain including stainability, sensitivity, specificity, and consistency of stainings. Results No significant issues were encountered during tissue processing and sectioning. On H&E stain, 97.5% (78/80) of slides showed good-quality staining, demonstrating clear histological properties of the thrombus tissue as red blood cells (RBC) stained in red, fibrin/platelet stained in pink, and nuclei stained in blue with intranuclear detail. The same histological features were also successfully demonstrated on MSB for all 80 samples. One of the 80 samples (1.2%) showed that RBC lost stainability on H&E due to tissue autolysis. Clear positive signal of platelet staining was expressed in 98.8% of the samples (79/80) with minimal background staining on IHC. There was no significant difference in staining quality across different formalin fixation groups. Conclusion A good quality of histopathological staining is achievable for the thrombus tissue fixed in 10% neutral buffered formalin for up to 2 years. The findings are limited to the thrombus tissue retrieved by MT and specific fixation and staining protocols used in the study. To apply these results to other tissue or experimental setups, further studies and validations would be necessary. Clinical trial registration This study was conducted as part of the EXCELLENT study: www.clinicaltrials.gov, unique identifier: NCT03685578.
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Affiliation(s)
- Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Collin Johnson
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Oana M. Mereuta
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
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Liu Y, Dai D, Abbasi M, Mereuta OM, Gamb SI, Kadirvel R, Kallmes DF, Brinjikji W. An in vitro model for Extracellular DNA Traps (ETs)-rich Human Thrombus Analogs. J Neurointerv Surg 2023; 15:589-593. [PMID: 35483911 PMCID: PMC11094997 DOI: 10.1136/neurintsurg-2022-018790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Extracellular DNA traps (ETs) have important implications in both thrombosis and thrombolysis. Thus, developing benchtop thrombus analogs that recapitulate clinical ETs is potentially of great value for preclinical development and testing of thrombolytic agents and thrombectomy devices. In this study, we aimed to develop ETs-rich thrombus analogs for preclinical testing. METHODS Red blood cell (RBC)-rich, fibrin-rich, and platelet-rich thrombus analogs were created using human whole blood, platelet-poor plasma, and platelet-rich plasma obtained from the blood bank following institutional approval. Peripheral blood mononuclear cells (9.9×106 cells/mL) isolated from human whole blood and lipopolysaccharide (1 µg/mL) were added to induce ETs. Histochemical, immunohistochemistry and immunofluorescence were used to identify thrombus components and ETs. Scanning electronic microscopy was used to investigate the ultrastructure of the thrombus analogs. The thrombus compositions, morphologic features of ETs and citrullinated histone H3 (H3Cit) expression were compared with those of thrombi retrieved from patients by thrombectomy. RESULTS ETs-rich thrombus analogs were more compacted th-an the ETs-poor thrombus analogs. ETs were identified in both ETs-rich thrombus analogs and patient thrombi showing morphologic features including nuclear lobulation, nuclear swelling, diffused chromatin within cytoplasm, DNA/chromatin extending intracellularly and extracellularly, and extracellular chromatin patches and bundles. In the ETs-poor thrombus analogs, ETs were not observed and H3Cit expression was absent to minimal. The compositions and H3Cit expression in the ETs-rich thrombus analogs fell in the range of patient thrombi. CONCLUSIONS ETs-rich thrombus analogs can be consistently created in vitro and may benefit the preclinical development and testing of new thrombolytic agents and thrombectomy devices.
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Affiliation(s)
- Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Global Institute of Future Technology, Shanghai Jiao Tong University, Shanghai, China
| | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Scott I Gamb
- Electron Microscopy Core Facility, Mayo Clinic, Rochester, Minnesota, USA
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Mereuta OM, Agarwal T, Ghozy S, Dai D, Arul S, Brinjikji W, Kallmes DF, Kadirvel R. Shell Versus Core Architecture and Biology of Thrombi in Acute Ischemic Stroke: A Systematic Review. Clin Appl Thromb Hemost 2023; 29:10760296231213632. [PMID: 37960892 PMCID: PMC10647960 DOI: 10.1177/10760296231213632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The presence of an outer shell has been recently described as a common feature of acute ischemic stroke (AIS) thrombi. We performed a systematic review of the current literature on shell genesis, structure, and clinical significance. METHODS Following PRISMA guidelines, we searched Ovid Cochrane Central Register of Controlled Trials, Embase, Medline, Scopus, and Web of Science for studies reporting the composition and structure of AIS thrombi and clot analogs. Identified studies were added to Covidence software for primary screening. Two reviewers independently screened titles and abstracts followed by full-text screening. RESULTS From 1290 identified studies, 10 were included in this review. Studies using histology/immunohistochemistry/immunofluorescence described fibrin, platelets, von Willebrand factor, and neutrophil extracellular traps as the main components of the shell. Scanning electron microscopy demonstrated a dense, compact fibrin/platelet-rich shell, and a core rich in polyhedrocytes. Microfluidics studies identified highly activated P-selectin-positive platelets and fibrin forming the core while secondary agonists adenosine diphosphate and thromboxane, along with loosely packed P-selectin-negative platelets constituted the shell. CONCLUSIONS The composition, compaction, and integrity of the shell may impact thrombolysis and revascularization outcomes. The preponderance of studies supported this conclusion.
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Affiliation(s)
| | - Tamanna Agarwal
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Santhosh Arul
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | - Ram Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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6
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Liu Y, Brinjikji W, Abbasi M, Dai D, Arturo Larco JL, Madhani SI, Shahid AH, Mereuta OM, Nogueira RG, Kvamme P, Layton KF, Delgado Almandoz JE, Hanel RA, Mendes Pereira V, Almekhlafi MA, Yoo AJ, Jahromi BS, Gounis MJ, Patel B, Fitzgerald S, Doyle K, Haussen DC, Al-Bayati AR, Mohammaden M, Pisani L, Rodrigues GM, Thacker IC, Kayan Y, Copelan A, Aghaebrahim A, Sauvageau E, Demchuk AM, Bhuva P, Soomro J, Nazari P, Cantrell DR, Puri AS, Entwistle J, Kadirvel R, Cloft HJ, Kallmes DF, Savastano L. Quantification of clot spatial heterogeneity and its impact on thrombectomy. J Neurointerv Surg 2022; 14:1248-1252. [PMID: 34911736 DOI: 10.1136/neurintsurg-2021-018183] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Compositional and structural features of retrieved clots by thrombectomy can provide insight into improving the endovascular treatment of ischemic stroke. Currently, histological analysis is limited to quantification of compositions and qualitative description of the clot structure. We hypothesized that heterogeneous clots would be prone to poorer recanalization rates and performed a quantitative analysis to test this hypothesis. METHODS We collected and did histology on clots retrieved by mechanical thrombectomy from 157 stroke cases (107 achieved first-pass effect (FPE) and 50 did not). Using an in-house algorithm, the scanned images were divided into grids (with sizes of 0.2, 0.3, 0.4, 0.5, and 0.6 mm) and the extent of non-uniformity of RBC distribution was computed using the proposed spatial heterogeneity index (SHI). Finally, we validated the clinical significance of clot heterogeneity using the Mann-Whitney test and an artificial neural network (ANN) model. RESULTS For cases with FPE, SHI values were smaller (0.033 vs 0.039 for grid size of 0.4 mm, P=0.028) compared with those without. In comparison, the clot composition was not statistically different between those two groups. From the ANN model, clot heterogeneity was the most important factor, followed by fibrin content, thrombectomy techniques, red blood cell content, clot area, platelet content, etiology, and admission of intravenous tissue plasminogen activator (IV-tPA). No statistical difference of clot heterogeneity was found for different etiologies, thrombectomy techniques, and IV-tPA administration. CONCLUSIONS Clot heterogeneity can affect the clot response to thrombectomy devices and is associated with lower FPE. SHI can be a useful metric to quantify clot heterogeneity.
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Affiliation(s)
- Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | - Raul G Nogueira
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter Kvamme
- Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Kennith F Layton
- NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Ricardo A Hanel
- Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Albert J Yoo
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Babak S Jahromi
- Radiology and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J Gounis
- Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Biraj Patel
- Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Seán Fitzgerald
- Department of Physiology and CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Karen Doyle
- Department of Physiology and CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Diogo C Haussen
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Leonardo Pisani
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Ike C Thacker
- NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- NeuroInterventional Radiology, Abbot Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Alexander Copelan
- NeuroInterventional Radiology, Abbot Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Amin Aghaebrahim
- Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Parita Bhuva
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Jazba Soomro
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Pouya Nazari
- Radiology and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald Robert Cantrell
- Radiology and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ajit S Puri
- Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - John Entwistle
- Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | | | - Harry J Cloft
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Larco JA, Abbasi M, Madhani SI, Mereuta MO, Liu Y, Dai D, Kadirvel R, Savastano L, Kallmes DF, Brinjikji W. Correlation of Neutrophil to Lymphocyte Ratio with Expression of Neutrophil Extracellular Traps Within Stroke Emboli. Interv Neuroradiol 2022; 28:726-730. [PMID: 34878323 PMCID: PMC9706263 DOI: 10.1177/15910199211065530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- Jorge Arturo Larco
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Luis Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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8
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Xu W, Xing XY, Xu JQ, Cao D, He Q, Dai D, Jia SC, Cheng QY, Lyu YL, Zhang L, Liang L, Xie GD, Chen YJ, Wang HD, Liu ZR. [A cross-sectional study of prevalence of chronic kidney disease and related factors in adults in Anhui province]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1717-1723. [PMID: 36444453 DOI: 10.3760/cma.j.cn112338-20220314-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To understand the prevalence of chronic kidney disease (CKD) and related factors in adults in Anhui province based on the data of Chinese Chronic Diseases and Nutrition Surveillance program (2018) in Anhui. Methods: Multi-stage stratified cluster random sampling was used to select participants aged ≥18 years. Moreover, questionnaire survey, body measurements and laboratory tests were conducted. The complex weighting method was used to estimate the prevalence of CKD in residents with different characteristics, and complex sampling data logistic regression model was used for multivariate analysis to identify related risk factors. Results: A total of 7 181 participants were included. The overall prevalence of CKD was 11.06% in adults in Anhui, and the prevalence was 12.49% in women and 9.59% in men (P<0.05). The moderate, high and very high risk for CKD progression were 8.66%, 2.02% and 0.38%, respectively. Multivariate analysis showed that age (OR=1.03, 95%CI: 1.00-1.05), BMI (OR=1.05, 95%CI: 1.01-1.09), being woman (OR=1.38,95%CI: 1.22-1.55), hypertension (OR=2.50, 95%CI: 1.76-3.56), diabetes (OR=2.28, 95%CI: 1.51-3.43), dyslipidemia (OR=1.26, 95%CI: 1.11-1.43) and hyperuricemia (OR=2.16, 95%CI: 1.68-2.78) were risk factors for CKD. Conclusion: The prevalence of CKD in adults in Anhui was relatively high and age, gender, BMI, hypertension, diabetes, dyslipidemia and hyperuricemia were found to be associated with the prevalence of CKD. To prevent CKD and its complications, attention should be paid to the management of related risk factors, including overweight and obesity, hypertension, diabetes, dyslipidemia and hyperuricemia.
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Affiliation(s)
- W Xu
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - X Y Xing
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - J Q Xu
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - D Cao
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - Q He
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - D Dai
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - S C Jia
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - Q Y Cheng
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - Y L Lyu
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - L Zhang
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - L Liang
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - G D Xie
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - Y J Chen
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - H D Wang
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
| | - Z R Liu
- Department of Chronic Non-communicable Diseases, Anhui Provincial Center for Disease Control and Prevention/Public Health Research Institute of Anhui Provincial, Hefei 230601, China
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9
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Mereuta OM, Abbasi M, Arturo Larco JL, Dai D, Liu Y, Arul S, Kadirvel R, Hanel RA, Yoo AJ, Almekhlafi MA, Layton KF, Delgado Almandoz JE, Kvamme P, Mendes Pereira V, Jahromi BS, Nogueira RG, Gounis MJ, Patel B, Aghaebrahim A, Sauvageau E, Bhuva P, Soomro J, Demchuk AM, Thacker IC, Kayan Y, Copelan A, Nazari P, Cantrell DR, Haussen DC, Al-Bayati AR, Mohammaden M, Pisani L, Rodrigues GM, Puri AS, Entwistle J, Meves A, Savastano L, Cloft HJ, Nimjee SM, McBane Ii RD, Kallmes DF, Brinjikji W. Correlation of von Willebrand factor and platelets with acute ischemic stroke etiology and revascularization outcome: an immunohistochemical study. J Neurointerv Surg 2022; 15:488-494. [PMID: 35595407 DOI: 10.1136/neurintsurg-2022-018645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Platelets and von Willebrand factor (vWF) are key components of acute ischemic stroke (AIS) emboli. We aimed to investigate the CD42b (platelets)/vWF expression, its association with stroke etiology and the impact these components may have on the clinical/procedural parameters. METHODS CD42b/vWF immunostaining was performed on 288 emboli collected as part of the multicenter STRIP Registry. CD42b/VWF expression and distribution were evaluated. Student's t-test and χ2 test were performed as appropriate. RESULTS The mean CD42b and VWF content in clots was 44.3% and 21.9%, respectively. There was a positive correlation between platelets and vWF (r=0.64, p<0.001**). We found a significantly higher vWF level in the other determined etiology (p=0.016*) and cryptogenic (p=0.049*) groups compared with cardioembolic etiology. No significant difference in CD42b content was found across the etiology subtypes. CD42b/vWF patterns were significantly associated with stroke etiology (p=0.006*). The peripheral pattern was predominant in atherosclerotic clots (36.4%) while the clustering (patchy) pattern was significantly associated with cardioembolic and cryptogenic origin (66.7% and 49.8%, respectively). The clots corresponding to other determined etiology showed mainly a diffuse pattern (28.1%). Two types of platelets were distinguished within the CD42b-positive clusters in all emboli: vWF-positive platelets were observed at the center, surrounded by vWF-negative platelets. Thrombolysis correlated with a high platelet content (p=0.03*). vWF-poor and peripheral CD42b/vWF pattern correlated with first pass effect (p=0.03* and p=0.04*, respectively). CONCLUSIONS The vWF level and CD42b/vWF distribution pattern in emboli were correlated with AIS etiology and revascularization outcome. Platelet content was associated with response to thrombolysis.
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Affiliation(s)
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorge L Arturo Larco
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Santhosh Arul
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Albert J Yoo
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Josser E Delgado Almandoz
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Peter Kvamme
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Vitor Mendes Pereira
- Departments of Medical Imaging and Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Babak S Jahromi
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - Biraj Patel
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Amin Aghaebrahim
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Parita Bhuva
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Jazba Soomro
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ike C Thacker
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Alexander Copelan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pouya Nazari
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Donald Robert Cantrell
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Mahmoud Mohammaden
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Gabriel Martins Rodrigues
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - John Entwistle
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid M Nimjee
- Department of Neurological Surgery, Ohio State University, Columbus, Ohio, USA
| | - Robert D McBane Ii
- Gonda Vascular Center, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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10
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Ding YH, Ghozy S, Dai D, Brinjikji W, Kallmes DF, Kadirvel R. Rabbit Elastase Aneurysm Model Mimics the Recurrence Rate of Human Intracranial Aneurysms following Platinum Coil Embolization. AJNR Am J Neuroradiol 2022; 43:741-747. [PMID: 35483907 PMCID: PMC9089251 DOI: 10.3174/ajnr.a7497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms treated with coils have been associated with incomplete occlusion, particularly in large or wide-neck aneurysms. This study aimed to validate the accuracy of the rabbit elastase model in predicting aneurysm recurrence in humans treated with platinum coils. MATERIALS AND METHODS Elastase-induced saccular aneurysms were induced in rabbits and embolized with conventional platinum coils. The recurrence rates of aneurysms were retrospectively analyzed. Morphologic characteristics of aneurysms, angiographic outcomes, and histologic healing were evaluated. RESULTS A total of 28 (15.3%) of 183 aneurysms recurred. The aneurysm recurrence rate observed in this study (15.3%) is similar to those reported in multiple analyses of aneurysm recurrence rates in humans (7%-27%). The rate of recurrence was higher in aneurysms treated without balloon assistance (19/66, 28.8%) compared with those treated with balloon assistance (9/117, 7.7%). Aneurysms treated with balloon-assisted coiling had a lower recurrence rate (OR = 0.17; 95% CI, 0.05-0.47; P = .001) and higher occlusion rate (OR = 6.88; 95% CI, 2.58-20.37; P < .001) compared with those treated without balloon-assisted coiling. In this rabbit elastase-induced aneurysm model, packing density and aneurysm volume were weak predictors of aneurysm recurrence; however, the packing density was a good predictor of the occlusion rate (OR = 1.05; 95% CI, 1.02-1.10; P = .008). CONCLUSIONS The rabbit elastase aneurysm model may mimic aneurysm recurrence rates observed in humans after platinum coil embolization. Moreover, balloon assistance and high packing densities were significant predictors of aneurysm recurrence and occlusion.
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Affiliation(s)
- Y-H Ding
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - S Ghozy
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D Dai
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - R Kadirvel
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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11
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Brinjikji W, Abbasi M, Mereuta OM, Fitzgerald S, Larco JA, Dai D, Kadirvel R, Nogueira RG, Kvamme P, Layton KF, Delgado JE, Hanel RA, Pereira VM, Almekhlafi MA, Yoo AJ, Jahromi BS, Gounis MJ, Patel BM, Savastano LE, Cloft HJ, Haussen DC, Al-Bayati A, Mohammaden M, Pisani L, Rodrigues G, Thacker IC, Kayan Y, Copelan AZ, Aghaebrahim A, Sauvageau E, Demchuk AM, Bhuva P, Soomro J, Nazari P, Cantrell DR, Puri AS, Doyle KM, Entwistle J, Kallmes DF. Histological composition of retrieved emboli in acute ischemic stroke is independent of pre-thrombectomy alteplase use. J Stroke Cerebrovasc Dis 2022; 31:106376. [PMID: 35183984 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Oana Madalina Mereuta
- 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
| | - Seán Fitzgerald
- 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
| | | | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA
| | - Peter Kvamme
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Josser E Delgado
- NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Vitor M Pereira
- Departments of Medical Imaging and Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Albert J Yoo
- Department of Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Babak S Jahromi
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, IL, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Biraj M Patel
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, VA, USA
| | - Luis E Savastano
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Diogo C Haussen
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA
| | - Alhamza Al-Bayati
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA
| | - Mahmoud Mohammaden
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA
| | - Gabriel Rodrigues
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA
| | - Ike C Thacker
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Alexander Z Copelan
- NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Amin Aghaebrahim
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Parita Bhuva
- Department of Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Jazba Soomro
- Department of Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Pouya Nazari
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, IL, USA
| | | | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Karen M Doyle
- Department of Physiology and CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - John Entwistle
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, VA, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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12
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Larco J, Abbasi M, Liu Y, Dai D, Lanzino G, Savastano L, Cloft H, Kallmes D, Kadirvel R, Brinjikji W. Postprocedural Thrombosis following Endovascular Treatment of Intracranial Aneurysm with Flow Diverters or Coiling: A Histologic Study. AJNR Am J Neuroradiol 2022; 43:258-264. [PMID: 34916206 PMCID: PMC8985686 DOI: 10.3174/ajnr.a7369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Endovascular treatment of aneurysms with flow diverters or coiling is sometimes complicated by intraprocedural or postprocedural thrombosis along or within the devices. Thrombus composition and structure associated with such complications may provide insights into mechanisms of thrombus formation and clinical strategies to remove the thrombus. We present a retrospective histopathologic study of 4 patients who underwent mechanical thrombectomy due to acute occlusion of either implanted flow diverter devices or along coils during the treatment of intracranial aneurysm.
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Affiliation(s)
- J.A. Larco
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - M. Abbasi
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - Y. Liu
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - D. Dai
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - G. Lanzino
- Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - L.E. Savastano
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - H. Cloft
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - D.F. Kallmes
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - R. Kadirvel
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - W. Brinjikji
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
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13
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Abbasi M, Arturo Larco J, Madhani SI, Mereuta OM, Dai D, KADIRVEL R, Savastano L, Kallmes DF, Brinjikji W. Abstract TP159: The Effect Of Diabetes Mellitus On Thrombus Composition In Patients With Stroke. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Outcomes of mechanical thrombectomy (MT) are influenced by the composition of thrombi. Amongst the risk factors affecting clot composition, diabetes mellitus (DM) may be associated with more thrombus structural and mechanical alterations resulting in fibrinolysis-resistant thrombi. However, extensive analysis of the composition of thrombi obtained from patients is needed to elucidate this relationship.
Hypothesis:
Thrombi retrieved from patients with DM may have different compositions compared to that of patients with no history of DM.
Methods:
MT retrieved-thrombi from patients suffering from large vessel occlusion (LVO) stroke were included. Thrombi sections were stained with Martius Scarlet Blue (MSB) for main thrombus components including red blood cells (RBCs), white blood cells (WBCs), fibrin and platelet. Additionally, immunohistochemistry (IHC) was performed to identify neutrophil extracellular traps (NETs) (anti-citrulinated H3; CitH3; NETs-specific marker) and von Willebrand Factor (vWF) in thrombi. Slides were then scanned and analyzed and the thrombus composition was compared between patients with or without a DM diagnosis at the time of stroke presentation.
Results:
A total of 140 patients were included of which 35 had a diagnosis of DM at stroke presentation. Baseline characteristics (excluding age), IV-tPA use prior to MT, and MT outcomes (number of device passes and final mTICI score) were similar between DM and non DM patients. The overall average percentage of RBCs, WBCs, fibrin, platelet, NETs (CitH3), and vWF components in thrombi were 47.4%, 3.2%, 27.4%, 21.8%, 25.9% and 17.6%, respectively. Thrombi from patients with DM were not statistically significant different from those of patients with no DM in terms of RBCs (44.3 vs 48.4 p=0.37), WBCs (2.7 vs 3.3 p=0.05), fibrin (29.5 vs 26.7 p=0.37), platelet (23.3 vs 21.3 p=0.57), NETs (25.6 vs 22.3 p=0.54), and vWF (17.5 vs 17.7 p=0.96).
Conclusion:
DM has no effect on the composition of thrombi as no significant difference was found in thrombi obtained from patients with and without DM.
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14
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Arturo Larco J, Abbasi M, Madhani SI, Dai D, KADIRVEL R, Savastano L, Kallmes DF, Brinjikji W. Abstract WP156: Association Of Thrombus Histopathology And Prognosis Of Successful Recanalization. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). Clinical outcome of successful recanalization (mTICI 2b or higher) varies greatly and is associated with some baseline characteristics. Many studies have reported the relation of thrombus composition with MT outcomes however the association of thrombus composition with the prognosis of successful recanalization remains to be elucidated.
Hypothesis:
thrombi retrieved from patients with good clinical outcome may have different compositions compared to that of patients with poor clinical outcome.
Methods:
Thrombi retrieved from AIS-LVO patients with successful recanalization were included. Patients were divided according to modified Rankin Scale at 90 days (mRS-90days) into good clinical outcome (mRS-90days 0-2) and poor clinical outcome (mRS-90 days 3-6). Representative slide for each thrombus was stained with Martius Scarlet Blue (MSB) for red blood cells (RBCs), white blood cells (WBCs), fibrin (FIB), and platelet (PLT). Immunohistochemistry (IHC) was also performed for NETs (anti-citrullinated H3; CitH3) and vWF in thrombi. The overall mean value of each thrombus composition was calculated. Thrombus was considered rich in given composition if that composition was higher than its overall mean. We compared the thrombus composition and type between patients with good and poor clinical outcomes.
Results:
A total of 94 patients were included. Fifty-six patients had good clinical outcome. The overall average percentage of RBCs, WBCs, fibrin, platelet, NETs (CitH3), and vWF components in thrombi were 44.3%, 3.6%, 29.3%, 22.8%, 20.3% and 12.5% respectively. There was no association between thrombus type (including RBC-rich, FIB-rich, PLT-rich, vWF-rich, and NETs-rich) and clinical outcomes (P values>0.05). Multivariate logistic regression analysis showed no association between thrombus composition and clinical outcome (good vs poor) while adjusting for age, initial NIHSS score, ASPECT score, pre-MT IV-tPA, and MT technique and number of the device passes.
Conclusion:
we found no association between thrombus composition and clinical outcome after successful recanalization.
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Abbasi M, Arturo Larco J, Mereuta MO, Liu Y, Fitzgerald S, Dai D, Kadirvel R, Savastano L, Kallmes DF, Brinjikji W. Diverse thrombus composition in thrombectomy stroke patients with longer time to recanalization. Thromb Res 2022; 209:99-104. [PMID: 34906857 PMCID: PMC8957257 DOI: 10.1016/j.thromres.2021.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Delayed time to recanalization is associated with reduced recanalization success of mechanical thrombectomy (MT) and thrombolysis in acute ischemic stroke (AIS). The reasons for this are unclear. We hypothesized that alterations in thrombus structure and composition could be responsible for this. METHODS Retrieved thrombi from AIS patients who underwent MT less than 8 h from symptom onset to groin puncture (SOGP) were evaluated. Patients were divided into early (≤4 h.) vs delayed (> 4 h) groups based SOGP timing. Thrombi were histologically analysed using Martius Scarlett Blue and immunohistochemistry staining for von Willebrand Factor (vWF), anti-citrullinated H3 (H3Cit; NETs [neutrophil extracellular traps] marker). We used inferential statistics including, t-test, artificial neural network (ANN) to interpret the data. RESULTS A total of 137 thrombi were collected. The overall average percentage of red blood cells (RBC), white blood cells (WBC), platelet, fibrin, H3Cit, and vWF components in thrombi was 45.83%, 3.58%, 22.23%, 28.27%, 19.97% and 16.23% respectively. Delayed group had higher WBCs, (p = 0.02), fibrin (p = 0.02), H3Cit (p = 0.04) and vWF (p = 0.03) thrombus fractions compared to early group. Based on ANN model, the most important factors for predicting the number of passes required for successful recanalization are fibrin and RBC contents of the thrombus followed by vWF and H3Cit contents. CONCLUSIONS Longer time to recanalization was associated with increased WBCs, fibrin, H3Cit and vWF fractions of thrombi reflecting possible in situ maturation of thrombus components. Increased fibrin, NETs and vWF composition may reduce likelihood of revascularization by altering thrombus mechanical properties.
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Affiliation(s)
- Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Jorge Arturo Larco
- Department of Radiology, Mayo Clinic, Rochester, MN, USA,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Seán Fitzgerald
- CÚRAM–Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Luis Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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16
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Ayers-Ringler J, McDonald JS, Connors MA, Fisher CR, Han S, Jakaitis DR, Scherer B, Tutor G, Wininger KM, Dai D, Choi DS, Salisbury JL, Jannetto PJ, Bornhorst JA, Kadirvel R, Kallmes DF, McDonald RJ. Neurologic Effects of Gadolinium Retention in the Brain after Gadolinium-based Contrast Agent Administration. Radiology 2021; 302:676-683. [PMID: 34931861 PMCID: PMC8893178 DOI: 10.1148/radiol.210559] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Concerns over the neurotoxic potential of retained gadolinium in brain tissues after intravenous gadolinium-based contrast agent (GBCA) administration have led to pronounced worldwide use changes, yet the clinical sequelae of gadolinium retention remain undefined. Purpose To assess clinical and neurologic effects and potential neurotoxicity of gadolinium retention in rats after administration of various GBCAs. Materials and Methods From March 2017 through July 2018, 183 male Wistar rats received 20 intravenous injections of 2.5 mmol per kilogram of body weight (80 human equivalent doses) of various GBCAs (gadodiamide, gadobenate, gadopentetate, gadoxetate, gadobutrol, gadoterate, and gadoteridol) or saline over 4 weeks. Rats were evaluated 6 and 34 weeks after injection with five behavioral tests, and inductively coupled plasma mass spectrometry, transmission electron microscopy, and histopathology were performed on urine, serum, cerebrospinal fluid (CSF), basal ganglia, dentate nucleus, and kidney samples. Dunnett post hoc test and Wilcoxon rank sum test were used to compare differences between treatment groups. Results No evidence of differences in any behavioral test was observed between GBCA-exposed rats and control animals at either 6 or 34 weeks (P = .08 to P = .99). Gadolinium concentrations in both neuroanatomic locations were higher in linear GBCA-exposed rats than macrocyclic GBCA-exposed rats at 6 and 34 weeks (P < .001). Gadolinium clearance over time varied among GBCAs, with gadobutrol having the largest clearance (median: 62% for basal ganglia, 70% for dentate) and gadodiamide having no substantial clearance. At 34 weeks, gadolinium was largely cleared from the CSF and serum of gadodiamide-, gadobenate-, gadoterate-, and gadobutrol-exposed rats, especially for the macrocyclic agents (range: 70%-98% removal for CSF, 34%-94% removal for serum), and was nearly completely removed from urine (range: 96%-99% removal). Transmission electron microscopy was used to detect gadolinium foci in linear GBCA-exposed brain tissue, but no histopathologic differences were observed for any GBCA. Conclusion In this rat model, no clinical evidence of neurotoxicity was observed after exposure to linear and macrocyclic gadolinium-based contrast agents at supradiagnostic doses. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Jennifer Ayers-Ringler
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Jennifer S. McDonald
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Margaret A. Connors
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Cody R. Fisher
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Susie Han
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Daniel R. Jakaitis
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Bradley Scherer
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Gabriel Tutor
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Katheryn M. Wininger
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Daying Dai
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Doo-Sup Choi
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Jeffrey L. Salisbury
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Paul J. Jannetto
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Joshua A. Bornhorst
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Ram Kadirvel
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - David F. Kallmes
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Robert J. McDonald
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Yang Y, Si J, Lv X, Dai D, Liu L, Tang S, Wang Y, Zhang S, Xiao W, Zhang Y. Integrated analysis of whole genome and transcriptome sequencing reveals a frameshift mutation associated with recessive embryonic lethality in Holstein cattle. Anim Genet 2021; 53:137-141. [PMID: 34873723 DOI: 10.1111/age.13160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022]
Abstract
Embryo loss is an important factor affecting fertility in dairy production. HH2 was identified as a haplotype on chromosome 1 associated with embryonic lethality in Holstein cattle. In the current study, both short- and long-read WGS was performed on four carriers and four non-carriers of HH2 to screen for variants in concordance with HH2 haplotype status. Sequence variation analysis revealed five putative functional variants of protein-coding genes, including a frameshift mutation (g.107172616delT) in intraflagellar transport protein 80 (IFT80) gene. Transcriptome analysis of whole blood indicated that no gene exhibited significantly differential expression or allele-specific expression between carriers and non-carriers in the candidate region. This evidence points to g.107172616delT as the highest priority causative mutation for HH2. Protein prediction reveals that the frameshift mutation results in a premature stop codon to reduce the peptide chain from 760 to 383 amino acids and greatly alters the structure and function of IFT80 protein. Our results demonstrate that the use of a combination of multiple high-throughput sequencing technologies is an efficient strategy to screen for the candidate causative mutations responsible for Mendelian traits, including genetic disorders.
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Affiliation(s)
- Y Yang
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction of Ministry of Agriculture and Rural Affairs, College of Animal Science and Technology, China Agricultural University, Beijing, 100193, China
| | - J Si
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction of Ministry of Agriculture and Rural Affairs, College of Animal Science and Technology, China Agricultural University, Beijing, 100193, China
| | - X Lv
- Beijing Dairy Cattle Center, Beijing, 100192, China
| | - D Dai
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction of Ministry of Agriculture and Rural Affairs, College of Animal Science and Technology, China Agricultural University, Beijing, 100193, China
| | - L Liu
- Beijing Dairy Cattle Center, Beijing, 100192, China
| | - S Tang
- Beijing Animal Husbandry Station, Beijing, 100107, China
| | - Y Wang
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction of Ministry of Agriculture and Rural Affairs, College of Animal Science and Technology, China Agricultural University, Beijing, 100193, China
| | - S Zhang
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction of Ministry of Agriculture and Rural Affairs, College of Animal Science and Technology, China Agricultural University, Beijing, 100193, China
| | - W Xiao
- Beijing Animal Husbandry Station, Beijing, 100107, China
| | - Y Zhang
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction of Ministry of Agriculture and Rural Affairs, College of Animal Science and Technology, China Agricultural University, Beijing, 100193, China
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Abbasi M, Mereuta OM, Fitzgerald SF, Dai D, Rabinstein AA, Kadirvel R, Kallmes DF, Brinjikji W. Association of antithrombotic medications and composition of thrombi retrieved by mechanical thrombectomy in acute ischemic stroke. Thromb Res 2021; 207:99-101. [PMID: 34597887 DOI: 10.1016/j.thromres.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Oana Madalina Mereuta
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Physiology, CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Sean F Fitzgerald
- Department of Physiology, CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
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Brinjikji W, Madalina Mereuta O, Dai D, Kallmes DF, Savastano L, Liu Y, Nimjee SM, Nogueira RG, Abbasi M, Kadirvel R. Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke: lessons from retrieved stroke emboli. Stroke Vasc Neurol 2021; 6:658-667. [PMID: 34312319 PMCID: PMC8717785 DOI: 10.1136/svn-2021-001032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
There has been growing interest and insight into the histological composition of retrieved stroke emboli. One of the main focuses of the stroke clot analysis literature has been the implications of clot composition on mechanical thrombectomy procedures. However, the holy grail of clot analysis may not be in the field of clot–device interaction, but rather, in understanding mechanisms of fibrinolysis resistance. The mechanisms underlying the low response to fibrinolytic therapy, even with the newer, more powerful agents, remain poorly understood. While factors such as embolus size, location and collateral status influence alteplase delivery and recanalisation rates; compositional analyses focused on histological and ultrastructural characteristics offer unique insights into mechanisms of alteplase resistance. In this review, we strive to provide comprehensive review of current knowledge on clot composition and ultrastructural analyses that help explain resistance to fibrinolysis.
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Affiliation(s)
- Waleed Brinjikji
- Radiology, Mayo Clinic, Rochester, Minnesota, USA .,Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid M Nimjee
- Neurosurgery, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Raul G Nogueira
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Ding Y, Abbasi M, Liu Y, Dai D, Kadirvel R, Kallmes DF, Brinjikji W. In Vitro Study of Blood Clot Identification and Composition Assessment by Different Magnetic Resonance Sequences. Cureus 2021; 13:e16229. [PMID: 34367828 PMCID: PMC8343555 DOI: 10.7759/cureus.16229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Growing data suggest that clot composition can impact revascularization outcomes and can potentially guide treatment strategies for stroke patients with large vessel occlusion. We performed an in vitro study to determine which magnetic resonance (MR) signaling characteristics correlate with clot compositions. Methodology A total of 25 clot analogs were prepared by mixing human plasma and red blood cells (RBCs) with five different combinations (five samples for each combination), namely, Group A, fibrin-rich (95% plasma:5% RBCs); Group B, fibrin-rich (75% plasma:25% RBCs); Group C, intermediate (50% plasma:50% RBCs); Group D, RBC-rich (25% plasma:75% RBCs), and Group E, RBC-rich (5% plasma:95% RBCs). The prepared samples were then scanned with quantitative T2* mapping, T2 fast spin-echo (FSE), T2 gradient-echo (GRE), fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted angiography (SWAN). Thrombus-T2* relaxation time (TT2*RT) and signal intensity (SI) from different scanning sequences were measured in all groups. SIs between different groups were compared using a one-way analysis of variance. Correlation between TT2*RT and SI was determined using the Pearson correlation test. Results The average TT2*RT decreased from 126 ms to 37 ms from fibrin-rich to RBC-rich clots (Groups A to E). Mean SIs of Groups D and E were lower than Groups A, B, and C on T2 mapping, T2 FSE, T2 GRE, FLAIR, and SWAN images (p < 0.00001). TT2*RT and SI were positively correlated on T2 mapping (R = 0.9628, p = 0.009). Conclusion Different compositions of blood clots can show different TT2*RT and SI on MR imaging. Quantitative T2* mapping and multicontrast MR scanning can help in the characterization of clots causing large vessel occlusion, which is useful to establish treatment strategies for stroke patients.
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Affiliation(s)
| | | | - Yang Liu
- Radiology, Mayo Clinic, Rochester, USA
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Abbasi M, Dai D, Liu Y, Fitzgerald S, Kadirvel R, Savastano LE, Cloft H, Kallmes DF, Brinjikji W. Iatrogenic Foreign Materials Associated with Retrieved Clot Tissue via Mechanical Thrombectomy. AJNR Am J Neuroradiol 2021; 42:1239-1249. [PMID: 34255735 DOI: 10.3174/ajnr.a7106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Hydrophilic polymers and polytetrafluoroethylene liners, commonly used in the construction of endovascular devices, occasionally separate from devices with subsequent embolization. We determined the frequency of such materials in thrombus specimens retrieved by mechanical thrombectomy in patients with stroke. MATERIALS AND METHODS We retrospectively reviewed H&E-stained thrombus sections for presence and types of foreign materials. We identified 4 types of foreign materials-Type I: material was light green with refraction and had a homogeneous texture; type II: material was light gray and/or dark gray, thin, and loose or attenuated in texture; type III: material was light green with refraction, solitary in texture, irregular in shape, and was often associated with round or oval bubblelike particles and/or diffuse black particles; and type IV: material had homogeneous texture and was light pink or red. In addition, polymer materials from different layers of used mechanical thrombectomy catheters were compared with the foreign materials found in thrombus specimens. RESULTS A total of 101 thrombi were evaluated. Foreign materials were found in 53 (52.5%) thrombus samples. The most common type was type I (92%), followed by type II (30%). The histopathologic features of the polymer materials from mechanical thrombectomy catheters were similar to the foreign materials found in thrombus specimens. The inner polytetrafluoroethylene liner and coating layer of catheters resembled type I and type II of the foreign materials, respectively. CONCLUSIONS Foreign polymer materials are present in approximately half of retrieved thrombi, most commonly polytetrafluoroethylene from catheter liners and less from hydrophilic coatings.
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Affiliation(s)
- M Abbasi
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
| | - D Dai
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
| | - Y Liu
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
| | - S Fitzgerald
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
| | - R Kadirvel
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
| | - L E Savastano
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
- Neurosurgery (L.E.S.), Mayo Clinic, Rochester, Minnesota
| | - H Cloft
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
| | - D F Kallmes
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
| | - W Brinjikji
- Departments of Radiology (M.A., D.D., Y.L., S.F., R.K., L.E.S., H.C., D.F.K. W.B.)
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22
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Ayers-Ringler J, Kolumam Parameswaran P, Khashim Z, Dai D, Ding YH, Kallmes DF, Kadirvel R. L-Arginine reduces downstream vascular contractility after flow-diverting device deployment: A preliminary study in a rabbit model. Interv Neuroradiol 2021; 28:183-189. [PMID: 34120493 DOI: 10.1177/15910199211025107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Flow diverters (FDs) are an effective treatment for intracranial aneurysms, though not free from hemorrhagic complications. A previous study demonstrated increased vascular contractility after FD-implantation as a potential mechanism of distal complications. Our study aimed to investigate whether L-arginine medication affects vascular contractility following FD deployment in a rabbit model. METHODS FDs were implanted in the aorta of normal rabbits (+FD, n = 10), with sham-operated aorta as controls (n = 5). L-Arginine was given in the drinking water (2.25% L-arginine hydrochloride) of half of the +FD animals (+FD/+Arg). Force contraction vascular contractility studies were performed on the aortic rings proximal and distal to the FD using an organ bath. Total eNOS, eNOS(pS1177), eNOS(pT495), COX-2, and S100A4 were quantified by western analysis on total protein lysates from aortic segments, normalizing to GAPDH. RESULTS Mean vascular contractility was 53% higher in distal relative to proximal aortic segments (P = 0.0038) in +FD animals, but were not significantly different in +FD/+Arg animals, or in sham-operated controls. The +FD animals expressed significantly reduced levels of eNOS(pS1177) than sham-operated controls (P = 0.0335), while both the +FD and +FD/+Arg groups had reduced levels of eNOS(pT495) relative to sham-operated controls (P = 0.0331 and P = 0.0311, respectively). CONCLUSION These results suggest that L-arginine medication reduces distal vascular contractility after FD treatment via nitric oxide production and thus might mitigate risk for downstream complications.
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Affiliation(s)
| | | | - Zenith Khashim
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, MN, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Yong-Hong Ding
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
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23
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Mereuta OM, Abbasi M, Fitzgerald S, Dai D, Kadirvel R, Hanel RA, Yoo AJ, Almekhlafi MA, Layton KF, Delgado Almandoz JE, Kvamme P, Mendes Pereira V, Jahromi BS, Nogueira RG, Gounis MJ, Patel B, Aghaebrahim A, Sauvageau E, Bhuva P, Soomro J, Demchuk AM, Thacker IC, Kayan Y, Copelan A, Nazari P, Cantrell DR, Haussen DC, Al-Bayati AR, Mohammaden M, Pisani L, Rodrigues GM, Puri AS, Entwistle J, Meves A, Arturo Larco JL, Savastano L, Cloft HJ, Kallmes DF, Doyle KM, Brinjikji W. Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy. J Neurointerv Surg 2021; 14:356-361. [PMID: 33975922 PMCID: PMC8581068 DOI: 10.1136/neurintsurg-2021-017310] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/12/2022]
Abstract
Background Several animal studies have demonstrated that mechanical thrombectomy (MT) for acute ischemic stroke (AIS) may cause vessel wall injury (VWI). However, the histological changes in human cerebral arteries following MT are difficult to determine. Objective To investigate the occurrence of VWI during MT by histological and immunohistochemical evaluation of AIS clots. Methods As part of the multicenter STRIP registry, 277 clots from 237 patients were analyzed using Martius Scarlett Blue stain and immunohistochemistry for CD34 (endothelial cells) and smooth muscle actin (smooth muscle cells). Results MT devices used were aspiration catheters (100 cases), stentriever (101 cases), and both (36 cases). VWI was found in 33/277 clots (12%). There was no significant correlation between VWI and MT device. The degree of damage varied from grade I (mild intimal damage, 24 clots), to grade II (relevant intimal and subintimal damage, 3 clots), and III (severe injury, 6 clots). VWI clots contained significantly more erythrocytes (p=0.006*) and less platelets/other (p=0.005*) than non-VWI clots suggesting soft thrombus material. Thrombolysis correlated with a lower rate of VWI (p=0.04*). VWI cases showed a significantly higher number of passes (2 [1–4] vs 1 [1–3], p=0.028*) and poorer recanalization outcome (p=0.01*) than cases without VWI. Conclusions Histological markers of VWI were present in 12% of AIS thrombi, suggesting that VWI might be related to MT. VWI was associated with soft thrombus consistency, higher number of passes and poorer revascularization outcome. There was no significant correlation between VWI and MT device.
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Affiliation(s)
- Oana Madalina Mereuta
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA .,CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ram Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Albert J Yoo
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Josser E Delgado Almandoz
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Peter Kvamme
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Vitor Mendes Pereira
- Departments of Medical Imaging and Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Babak S Jahromi
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - Biraj Patel
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Amin Aghaebrahim
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Parita Bhuva
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Jazba Soomro
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ike C Thacker
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Alexander Copelan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pouya Nazari
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Donald Robert Cantrell
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Diogo C Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Mahmoud Mohammaden
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Gabriel Martins Rodrigues
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - John Entwistle
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorge L Arturo Larco
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Karen M Doyle
- CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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24
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Xu W, Xu JQ, Dai D, Zhu JJ, He Q, Xing XY, Chen YJ, Liu ZR. [Estimation of dietary salt intake in adult residents in Anhui province, 2019]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:823-826. [PMID: 34814473 DOI: 10.3760/cma.j.cn112338-20200703-00913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: Based on the data of the baseline survey of hypertension and sodium intake monitoring in Anhui province in 2019, the salt intake in adult residents was estimated. Methods: Multi-stage stratified cluster random sampling was used to select participants aged 18-69 years, questionnaire survey and related measurements were conducted. Salt intake in participants with different characteristics were estimated with complex sample and linearization of Taylor series based on design and the correlation between salt intake and blood pressure, waist circumference and BMI were tested by linear regression. Results: A total of 1 500 participants were included. The overall salt intake was 9.14 g/d, which was 9.84 g/d in men and 8.47 g/d in women (P<0.05). The differences in salt intake across different subgroups were significant (P<0.05). Univariate linear regression analysis showed that salt intake was positively correlated with SBP, DBP, waist circumference and BMI (P<0.05), while multivariate linear regression analysis (adjusted for other factors) only showed a positive correlation between salt intake and BMI (β=0.053,95%CI: 0.028-0.078, P<0.05). Conclusion: The dietary salt intake in adult residents in Anhui was higher than WHO recommendation, suggesting that public health education need to be taken to reduce salt intake.
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Affiliation(s)
- W Xu
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Heifei 230601, China
| | - J Q Xu
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Heifei 230601, China
| | - D Dai
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Heifei 230601, China
| | - J J Zhu
- Department of Chronic and Non-communicable Disease Control and Prevention, Wuhu Prefectural Center for Disease Control and Prevention, Wuhu 241000, China
| | - Q He
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Heifei 230601, China
| | - X Y Xing
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Heifei 230601, China
| | - Y J Chen
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Heifei 230601, China
| | - Z R Liu
- Anhui Provincial Center for Disease Control and Prevention, Heifei 230601, China
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25
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Fitzgerald ST, Liu Y, Dai D, Mereuta OM, Abbasi M, Larco JLA, Douglas AS, Kallmes DF, Savastano L, Doyle KM, Brinjikji W. Novel Human Acute Ischemic Stroke Blood Clot Analogs for In Vitro Thrombectomy Testing. AJNR Am J Neuroradiol 2021; 42:1250-1257. [PMID: 33832952 DOI: 10.3174/ajnr.a7102] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have successfully created blood clot analogs for in vitro endovascular device testing using animal blood of various species. Blood components vary greatly among species; therefore, creating clot analogs from human blood is likely a more accurate representation of thrombi formed in the human vasculature. MATERIALS AND METHODS Following approval from the Mayo Clinic institutional review board, human whole-blood and platelet donations were obtained from the blood transfusion service. Twelve clot analogs were created by combining different ratios of red blood cells + buffy coat, plasma, and platelets. Thrombin and calcium chloride were added to stimulate coagulation. Clot composition was assessed using histologic and immunohistochemical staining. To assess the similarities of mechanical properties to patient clots, 3 types of clot analogs (soft, elastic, and stiff) were selected for in vitro thrombectomy testing. RESULTS The range of histopathologic compositions produced is representative of clots removed during thrombectomy procedures. The red blood cell composition ranged from 8.9% to 91.4%, and fibrin composition ranged from 3.1% to 53.4%. Platelets (CD42b) and von Willebrand Factor ranged from 0.5% to 47.1% and 1.0% to 63.4%, respectively. The soft clots had the highest first-pass effect and successful revascularization rates followed by the elastic and stiff clots. Distal embolization events were observed when clot ingestion could not be achieved, requiring device pullback. The incidence rate of distal embolization was the highest for the stiff clots due to the weak clot/device integration. CONCLUSIONS Red blood cell-rich, fibrin-rich, and platelet-rich clot analogs that mimic clots retrieved from patients with acute ischemic stroke were created in vitro. Differing retrieval outcomes were confirmed using in vitro thrombectomy testing in a subset of clots.
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Affiliation(s)
- S T Fitzgerald
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.) .,Department of Physiology (S.T.F., O.M.M., A.S.D., K.M.D.)
| | - Y Liu
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.)
| | - D Dai
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.)
| | - O M Mereuta
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.).,Department of Physiology (S.T.F., O.M.M., A.S.D., K.M.D.).,SFI Centre for Research in Medical Devices (O.M.M., A.S.D., K.M.D.), National University of Ireland Galway, Galway, Ireland
| | - M Abbasi
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.)
| | - J L A Larco
- Neurosurgery (J.L.A.L., L.S., W.B.), Mayo Clinic, Rochester, Minnesota
| | - A S Douglas
- Department of Physiology (S.T.F., O.M.M., A.S.D., K.M.D.).,SFI Centre for Research in Medical Devices (O.M.M., A.S.D., K.M.D.), National University of Ireland Galway, Galway, Ireland
| | - D F Kallmes
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.)
| | - L Savastano
- Neurosurgery (J.L.A.L., L.S., W.B.), Mayo Clinic, Rochester, Minnesota
| | - K M Doyle
- Department of Physiology (S.T.F., O.M.M., A.S.D., K.M.D.).,SFI Centre for Research in Medical Devices (O.M.M., A.S.D., K.M.D.), National University of Ireland Galway, Galway, Ireland
| | - W Brinjikji
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.).,Neurosurgery (J.L.A.L., L.S., W.B.), Mayo Clinic, Rochester, Minnesota
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26
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Abbasi M, Kvamme P, Layton KF, Hanel RA, Almekhlafi MA, Delgado JE, Pereira VM, Patel BM, Jahromi BS, Yoo AJ, Nogueira RG, Gounis MJ, Fitzgerald S, Mereuta OM, Dai D, Kadirvel R, Kallmes DF, Doyle KM, Savastano LE, Cloft HJ, Liu Y, Thacker IC, Aghaebrahim A, Sauvageau E, Demchuk AM, Kayan Y, Copelan AZ, Entwistle J, Nazari P, Cantrell DR, Bhuva P, Soomro J, Haussen DC, Al-Bayati A, Mohammaden M, Pisani L, Rodrigues G, Puri AS, Brinjikji W. Per pass analysis of thrombus composition retrieved by mechanical thrombectomy. Interv Neuroradiol 2021; 27:815-820. [PMID: 33823621 DOI: 10.1177/15910199211009119] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND AIM Mechanical thrombectomy (MT) for large vessel occlusion often requires multiple passes to retrieve the entire thrombus load. In this multi-institutional study we sought to examine the composition of thrombus fragments retrieved with each pass during MT. METHODS Patients who required multiple passes during thrombectomy were included. Histopathological evaluation of thrombus fragments retrieved from each pass was performed using Martius Scarlet Blue staining and the composition of each thrombus component including RBC, fibrin and platelet was determined using image analysis software. RESULTS 154 patients underwent MT and 868 passes was performed which resulted in 263 thrombus fragments retrieval. The analysis of thrombus components per pass showed higher RBC, lower fibrin and platelet composition in the pass 1 and 2 when compared to pass 3 and passes 4 or more combined (P values <0.05). There were no significant differences between thrombus fragments retrieved in pass 1 and pass 2 in terms of RBC, WBC, fibrin, and platelet composition (P values >0.05). Similarly, when each composition of thrombus fragments retrieved in pass 3 and passes 4 or more combined were compared with each other, no significant difference was noted (P values >0.05). CONCLUSION Our findings confirm that thrombus fragments retrieved with each pass differed significantly in histological content. Fragments in the first passes were associated with lower fibrin and platelet composition compared to fragments retrieved in passes three and four or higher. Also, thrombus fragments retrieved after failed pass were associated with higher fibrin and platelet components.
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Affiliation(s)
- Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Peter Kvamme
- Department of Radiology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
| | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, FL, USA
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Josser E Delgado
- NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Vitor M Pereira
- Departments of Medical Imaging and Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Biraj M Patel
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, VA, USA
| | - Babak S Jahromi
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, IL, USA
| | - Albert J Yoo
- Department of Neurointervention, Texas Stroke Institute, Plano, TX, USA
| | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
| | - Seán Fitzgerald
- 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
| | - Oana M Mereuta
- 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
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Karen M Doyle
- Department of Physiology and CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Luis E Savastano
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ike C Thacker
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
| | - Amin Aghaebrahim
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, FL, USA
| | - Eric Sauvageau
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, FL, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Yasha Kayan
- NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Alexander Z Copelan
- NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - John Entwistle
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, VA, USA
| | - Pouya Nazari
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, IL, USA
| | | | - Parita Bhuva
- Department of Neurointervention, Texas Stroke Institute, Plano, TX, USA
| | - Jazba Soomro
- Department of Neurointervention, Texas Stroke Institute, Plano, TX, USA
| | - Diogo C Haussen
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | - Alhamza Al-Bayati
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | - Mahmoud Mohammaden
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | - Leonardo Pisani
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | - Gabriel Rodrigues
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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27
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Brinjikji W, Nogueira RG, Kvamme P, Layton KF, Delgado Almandoz JE, Hanel RA, Mendes Pereira V, Almekhlafi MA, Yoo AJ, Jahromi BS, Gounis MJ, Patel B, Abbasi M, Fitzgerald S, Mereuta OM, Dai D, Kadirvel R, Doyle K, Savastano L, Cloft HJ, Haussen DC, Al-Bayati AR, Mohammaden MH, Pisani L, Rodrigues GM, Thacker IC, Kayan Y, Copelan A, Aghaebrahim A, Sauvageau E, Demchuk AM, Bhuva P, Soomro J, Nazari P, Cantrell DR, Puri AS, Entwistle J, Polley EC, Kallmes DF. Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the Stroke Thromboembolism Registry of Imaging and Pathology. J Neurointerv Surg 2021; 13:594-598. [PMID: 33722963 DOI: 10.1136/neurintsurg-2020-017167] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/06/2021] [Accepted: 02/21/2021] [Indexed: 12/12/2022]
Abstract
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 χ2 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.
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Affiliation(s)
- Waleed Brinjikji
- Radiology, Mayo Clinic, Rochester, Minnesota, USA .,Neurosurgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Raul G Nogueira
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter Kvamme
- Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Kennith F Layton
- NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Ricardo A Hanel
- Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Albert J Yoo
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Babak S Jahromi
- Neurosurgery and Radiology, Northwestern University, Chicago, Illinois, USA
| | - Matthew J Gounis
- Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Biraj Patel
- Radiology, Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seán Fitzgerald
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | - Oana Madalina Mereuta
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Karen Doyle
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | - Luis Savastano
- Neurosurgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Diogo C Haussen
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Leonardo Pisani
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Ike C Thacker
- NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- Interventional Neuroradiology, Abbot Northwestern Hospital, 55435, Minnesota, USA
| | - Alexander Copelan
- Interventional Neuroradiology, Abbot Northwestern Hospital, 55435, Minnesota, USA
| | - Amin Aghaebrahim
- Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Andrew M Demchuk
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Parita Bhuva
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Jazba Soomro
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Pouya Nazari
- Neurosurgery and Radiology, Northwestern University, Chicago, Illinois, USA
| | | | - Ajit S Puri
- Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - John Entwistle
- Radiology, Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Eric C Polley
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
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Carlstrom LP, Perry A, Graffeo CS, Dai D, Ding YH, Jakaitis DR, Lu A, Rodgers S, Kreck T, Hoofer K, Gorny KR, Kadirvel R, Kallmes DF. Novel Focal Therapeutic Hypothermia Device for Treatment of Acute Neurologic Injury: Large Animal Safety and Efficacy Trial. Skull Base Surg 2021; 83:203-209. [DOI: 10.1055/s-0040-1721818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/11/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Objective Therapeutic hypothermia is a potentially powerful and controversial clinical tool for neuroprotection following acute neurologic pathology, particularly vascular injury. Indeed, therapeutic hypothermia remains a standard of care for postcardiac arrest ischemia and acute neonatal hypoxic-ischemic encephalopathy, improving both survival and outcomes. Although therapeutic hypothermia remains promising for cellular and systems-based neuronal protection in other neurologic injury states, the systemic side effects have limited clinical utility, confounded analysis of potential neurologic benefits, and precluded the completion of meaningful clinical trials.
Methods To address such limitations, we developed and tested a novel, minimally invasive, neurocritical care device that employs continuous circulation of cold saline through the pharyngeal region to deliver focal cerebrovascular cooling. We conducted a preclinical safety and efficacy trial in six adult porcine animals to assess the validity and functionality of the NeuroSave device, and assess cooling potential following middle cerebral artery occlusion (n = 2).
Results NeuroSave consistently lowered brain parenchymal temperature by a median of 9°C relative to core temperature within 60 minutes of initiation, including in ischemic cerebral parenchyma. The core body temperature experienced a maximal reduction of 2°C, or 5% of body temperature, with no associated adverse effects identified.
Conclusion The present study uses a large animal preclinical model to demonstrate the safety and efficacy of a novel, noninvasive device for the induction of robust and systemically safe hypothermia within the brain.
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Affiliation(s)
- Lucas P. Carlstrom
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Yong H. Ding
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel R. Jakaitis
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Aiming Lu
- Department of Medical Physics, Mayo Clinic, Rochester, Minnesota, United States
| | - Seth Rodgers
- NeuroSave Inc., San Francisco, California, United States
| | - Thomas Kreck
- NeuroSave Inc., San Francisco, California, United States
| | - Kelly Hoofer
- NeuroSave Inc., San Francisco, California, United States
| | - Krzysztof R. Gorny
- Department of Medical Physics, Mayo Clinic, Rochester, Minnesota, United States
| | | | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
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Ding Y, Abbasi M, Eltanahy AM, Jakaitis DR, Dai D, Kadirvel R, Kallmes DF, Brinjikji W. Assessment of Blood Clot Composition by Spectral Optical Coherence Tomography: An In Vitro Study. Neurointervention 2021; 16:29-33. [PMID: 33296954 PMCID: PMC7946555 DOI: 10.5469/neuroint.2020.00297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Optical coherence tomography (OCT) has the potential for in vivo clot composition characterization in difficult mechanical embolectomy cases. We performed an in vitro study to determine the OCT characteristics of red blood cells (RBCs) and fibrin rich clots. MATERIALS AND METHODS Analogues of 5 compositions of clots (5% to 95% RBCs from Group A to E) were created from human blood. The blood mixture was injected into the bifurcation of a 3D printed bifurcated silicone tube. The OPTISTM Integrated System (St. Jude Medical Inc.) was used to identify the magnitude of OCT signals from different compositions of clots. Martius Scarlett Blue trichrome (MSB) staining was performed to confirm the composition of RBCs and fibrin in each clot. RESULTS Group A and B showed less signal attenuation (less than 30%) from its surface to the inside, which indicated high penetration (low-back scattering). Group C indicated intermediate signal attenuation (60%) from its surface to inside the clots, in which signals were found even at the periphery of the clot. Group D and E were superficially signal rich with more signal attenuation (more than 80%) from its surface to the inside indicating low penetration (high-back scattering). Signal-free shadowing was shown in 3 clots in Group E. MSB staining indicated color change (from red in fibrin-rich clots to yellow in RBC-rich clots). CONCLUSION Different compositions of clots can be assessed using OCT. Fibrin-rich clots have homogeneous signals with high penetration, while RBC-rich clots can be recognized as superficially signal rich with low penetration.
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Affiliation(s)
- Yonghong Ding
- Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Mehdi Abbasi
- Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ahmed M. Eltanahy
- Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Daniel R. Jakaitis
- Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Daying Dai
- Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ramanathan Kadirvel
- Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David F. Kallmes
- Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Ding YH, Fitzgerald S, Liu Y, Dai D, Jakaitis D, Doyle K, Brinjikji W, Kallmes DF, Savastano L, Kadirvel R. A novel rabbit thromboembolic occlusion model. J Neurointerv Surg 2021; 13:1040-1043. [PMID: 33574137 DOI: 10.1136/neurintsurg-2020-017073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To develop a preclinical thromboembolic occlusion model for studying revascularization strategies. METHODS Clot analog with barium sulfate was injected into the distal aorta in 9 New Zealand white rabbits. The situation of aorta occlusion was compared among fibrin-rich (n=4), red blood cell (RBC)-rich (n=3), and whole blood clot analogs (n=2) using digital subtraction angiography. Arterial geometries, histologic features and circumferential stretch of the distal aorta in rabbits were compared with the common carotid artery in swine and the distal internal carotid artery (ICA) in humans. Aspiration thrombectomy and mechanical thrombectomy using a stent retriever were performed in two rabbits. RESULTS The aortic bifurcation was occluded after a single delivery of clot in 4 cases. It was occluded after the second clot injection in the 5 remaining rabbits. Fragmentation of RBC-rich clots occurred during clot injection in 2 cases. The mean diameters of the distal aorta and right common iliac artery in rabbits were 3.7±0.4 and 2.8±0.3 mm, respectively; the mean diameters of human ICA, and first and second segments of the middle cerebral artery (M1, M2) were 3.6±0.4, 3.1±0.4, and 2.4±0.4 mm, respectively. Arterial revascularization was achieved in both rabbits. Geometric, mechanical and histological factors of the distal aorta in rabbit were more close to human distal ICA than swine carotid artery. CONCLUSION Arterial occlusion can be achieved at the aortic bifurcation in rabbits, which is comparable to human ICA bifurcation. This thrombectomy model has the potential to be used for testing of thrombectomy devices.
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Affiliation(s)
| | - Seán Fitzgerald
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Karen Doyle
- Physiology, CURAM, National University of Ireland Galway, Galway, Ireland
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Koneru S, Nogueira RG, Osehobo E, Oprea-Ilies G, Al-Bayati AR, Brinjikji W, Dai D, Haussen DC. Clot composition in retrieved thrombi after mechanical thrombectomy in strokes due to carotid web. J Neurointerv Surg 2021; 13:530-533. [PMID: 33514611 DOI: 10.1136/neurintsurg-2020-017112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The 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. METHODS This 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. RESULTS Three 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. CONCLUSIONS The 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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Affiliation(s)
- Sitara Koneru
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Neurology, Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA
| | - Raul G Nogueira
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Neurology, Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA
| | - Ehizele Osehobo
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Neurology, Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA
| | | | - Alhamza R Al-Bayati
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Neurology, Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA
| | | | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Diogo C Haussen
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA .,Neurology, Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA
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Ding Y, Dai D, Rouchaud A, Janot K, Asnafi S, Kallmes DF, Kadirvel R. WEB Device Shape Changes in Elastase-Induced Aneurysms in Rabbits. AJNR Am J Neuroradiol 2021; 42:334-339. [PMID: 33303525 PMCID: PMC7872195 DOI: 10.3174/ajnr.a6899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/05/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE While WEB devices have been shown to be safe and effective for aneurysm treatment, WEB-shape modification compression has been associated with incomplete aneurysm occlusion. We explored the relationship between occlusion rates and WEB-shape modification in different WEB device types in an experimental aneurysm model. MATERIALS AND METHODS Elastase-induced aneurysms were created in rabbits and treated with dual-layer (n = 12), single-layer (n = 12), or single-layer sphere (n = 12) WEB devices. Aneurysms were followed up either at 3 or 12 months. Angiographic occlusion was graded using the WEB Occlusion Scale: grade I, complete; grade II, complete but recess filling; grade III, residual neck; or grade IV, residual aneurysm. WEB-shape modification and histologic features were also analyzed. RESULTS Grade I or II occlusion was seen in 16 (44%) aneurysms, and grade I, II, or III ("adequate") occlusion was observed in 22 (61.1%) aneurysms at follow-up. WEB-shape modification was observed in 22 (61.1%) aneurysms. WEB-shape modification was higher in single-layer (9/12) and dual-layer (10/12) devices compared with single-layer sphere devices (3/12). Aneurysms with WEB-shape modification had a higher level of thrombus organization in the dome compared with those without WEB-shape modification (68% [15/22] versus 50% [7/14]). WEB-shape modification was not correlated with angiographic or histologic outcomes but was significantly correlated with levels of fibrosis and smooth muscle cells in the aneurysm. CONCLUSIONS WEB-shape modification is not associated with incomplete aneurysm occlusion of WEB devices in the rabbit model but may be related to connective tissue formation and the healing response to WEB device implantation.
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Affiliation(s)
- Y Ding
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
| | - D Dai
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
| | - A Rouchaud
- Department of Interventional Neuroradiology (A.R.), University Hospital, Limoges, France
| | - K Janot
- Neuroradiology Department (K.J.), University Hospital of Tours, Tours, France
| | - S Asnafi
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
- Department of Radiology (S.A.), Emory University, Atlanta, Georgia
| | - D F Kallmes
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
| | - R Kadirvel
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
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Sang C, Kallmes DF, Kadirvel R, Durka MJ, Ding YH, Dai D, Watkins SC, Robertson AM. Adaptive Remodeling in the Elastase-induced Rabbit Aneurysms. Exp Mech 2021; 61:263-283. [PMID: 33814553 PMCID: PMC8011419 DOI: 10.1007/s11340-020-00671-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/29/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Rupture of brain aneurysms is associated with high fatality and morbidity rates. Through remodeling of the collagen matrix, many aneurysms can remain unruptured for decades, despite an enlarging and evolving geometry. OBJECTIVE Our objective was to explore this adaptive remodeling for the first time in an elastase induced aneurysm model in rabbits. METHODS Saccular aneurysms were created in 22 New Zealand white rabbits and remodeling was assessed in tissue harvested 2, 4, 8 and 12 weeks after creation. RESULTS The intramural principal stress ratio doubled after aneurysm creation due to increased longitudinal loads, triggering a remodeling response. A distinct wall layer with multi-directional collagen fibers developed between the media and adventitia as early as 2 weeks, and in all cases by 4 weeks with an average thickness of 50.6 ± 14.3 μm. Collagen fibers in this layer were multi-directional (AI = 0.56 ± 0.15) with low tortuosity (1.08 ± 0.02) compared with adjacent circumferentially aligned medial fibers (AI = 0.78 ± 0.12) and highly tortuous adventitial fibers (1.22 ± 0.03). A second phase of remodeling replaced circumferentially aligned fibers in the inner media with longitudinal fibers. A structurally motivated constitutive model with both remodeling modes was introduced along with methodology for determining material parameters from mechanical testing and multiphoton imaging. CONCLUSIONS A new mechanism was identified by which aneurysm walls can rapidly adapt to changes in load, ensuring the structural integrity of the aneurysm until a slower process of medial reorganization occurs. The rabbit model can be used to evaluate therapies to increase aneurysm wall stability.
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Affiliation(s)
- C Sang
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
| | - D F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - R Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - M J Durka
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
| | - Y-H Ding
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - D Dai
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - S C Watkins
- Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA
| | - A M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
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Mereuta OM, Fitzgerald S, Christensen TA, Jaspersen AL, Dai D, Abbasi M, Puttappa T, Kadirvel R, Kallmes DF, Doyle KM, Brinjikji W. High-resolution scanning electron microscopy for the analysis of three-dimensional ultrastructure of clots in acute ischemic stroke. J Neurointerv Surg 2020; 13:906-911. [PMID: 33361274 DOI: 10.1136/neurintsurg-2020-016709] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Characterization of acute ischemic stroke (AIS) clots has typically focused on two-dimensional histological analysis of the thrombus. The three-dimensional (3D) architecture and distribution of components within emboli have not been fully investigated. The aim of this study was to examine the composition and microstructure of AIS clots using histology and serial block-face scanning electron microscopy (SBFSEM). METHODS As part of the multi-institutional STRIP registry, 10 consecutive AIS emboli were collected from 10 patients treated by mechanical thrombectomy. Histological and immunohistochemical analysis was performed to determine clot composition. SBFSEM was used to assess the ultrastructural organization of the clots and specific features of individual components. RESULTS Quantification of Martius Scarlett Blue stain identified fibrin (44.4%) and red blood cells (RBCs, 32.6%) as the main components. Immunohistochemistry showed a mean platelet and von Willebrand factor content of 23.9% and 11.8%, respectively. The 3D organization of emboli varied greatly depending on the region analyzed. RBC-rich areas were composed mainly of tightly packed RBCs deformed into polyhedrocytes with scant fibrin fibers interwoven between cells. The regions with mixed composition showed thick fibrin fibers along with platelets, white blood cells and RBC clusters. Fibrin-rich areas contained dense fibrin masses with sparse RBC. In three cases, the fibrin formed a grid-like or a sponge-like pattern, likely due to thrombolytic treatment. Segmentation showed that fibrin fibers were thinner and less densely packed in these cases. CONCLUSIONS 3D-SEM provides novel and potentially clinically relevant information on clot components and ultrastructure which may help to inform thrombolytic treatment and medical device design.
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Affiliation(s)
- Oana Madalina Mereuta
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA .,Department of Physiology, CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology, CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | | | - Adam L Jaspersen
- Microscopy and Cell Analysis Core, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ram Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Karen M Doyle
- Department of Physiology, CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Dai D, Feng XD, Zhu WQ, Bao YN. LncRNA BLACAT1 regulates the viability, migration and invasion of oral squamous cell carcinoma cells by targeting miR-142-5p. Eur Rev Med Pharmacol Sci 2020; 23:10313-10323. [PMID: 31841186 DOI: 10.26355/eurrev_201912_19669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Oral squamous cell carcinoma (OSCC) is one of the most common head and neck tumors with high incidence and mortality. Long noncoding RNA bladder cancer-associated transcript 1 (lncRNA BLACAT1) was involved in several cancers development. However, the roles of BLACAT1 in OSCC have not been investigated. MATERIALS AND METHODS The expressions of BLACAT1 and miR-142-5p in OSCC cells were measured by quantitative real-time polymerase chain reaction (qRT-PCR). Cell viability was evaluated by MTT assay. Cell migration and invasion were evaluated by transwell migration assay and transwell invasion assay, respectively. The protein levels of CyclinD1, p21, p27, MMP-2, MMP-9 and MMP-14 were detected by Western blot analysis. The interaction of BLACAT1 and miR-142-5p was verified by luciferase reporter assay. RESULTS The expression of BLACAT1 was increased and the expression of miR-142-5p was decreased in OSCC cells. The knockdown of BLACAT1 suppressed the viability, migration and invasion of OSCC cells. miR-142-5p was identified as a target of BLACAT1 and BLACAT1 overexpression suppressed miR-142-5p expression. Furthermore, overexpression of miR-142-5p showed similar effects on OSCC cells viability, migration and invasion with BLACAT1 knockdown, and inhibition of miR-142-5p restored the effects of BLACAT1 knockdown OSCC cells viability, migration and invasion. CONCLUSIONS LncRNA BLACAT1 knockdown suppressed the viability, migration and invasion of OSCC cells by sponging miR-142-5p, indicating that BLACAT1 might be a novel target for the treatment of OSCC.
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Affiliation(s)
- D Dai
- Department of Stomatology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Liu W, Dai D, Ding YH, Liu Y, Temnyk K, Shen TW, Cardinal KO, Kallmes DF, Kadirvel R. Cellular responses to flow diverters in a tissue-engineered aneurysm model. J Neurointerv Surg 2020; 13:746-751. [PMID: 33158994 DOI: 10.1136/neurintsurg-2020-016593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Notwithstanding the widespread implementation of flow diverters (FDs) in the treatment of intracranial aneurysms, the exact mechanism of action of these devices remains elusive. We aimed to advance the understanding of cellular responses to FD implantation using a 3D tissue-engineered in vitro aneurysm model. METHODS Aneurysm-like blood vessel mimics (aBVMs) were constructed by electrospinning polycaprolactone nanofibers onto desired aneurysm-like geometries. aBVMs were seeded with human aortic smooth muscle cells (SMCs) followed by human aortic endothelial cells (ECs). FDs were then deployed in the parent vessel of aBVMs covering the aneurysm neck and were cultivated for 7, 14, or 28 days (n=3 for each time point). The EC and SMC coverage in the neck was measured semi-quantitatively. RESULTS At day 7, the device segment in contact with the parent vessel was partially endothelialized. Also, the majority of device struts, but not pores, at the parent vessel and neck interface were partially covered with ECs and SMCs, while device struts in the middle of the neck lacked cell coverage. At 14 days, histology verified a neointimal-like lining had formed, partially covering both the struts and pores in the center of the neck. At 28 days, the majority of the neck was covered with a translucent neointimal-like layer. A higher degree of cellular coverage was seen on the struts and pores at the neck at 28 days compared with both 7 and 14 days. CONCLUSION aBVMs can be a valuable alternative tool for evaluating the healing mechanisms of endovascular aneurysm devices.
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Affiliation(s)
- Wenjing Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Geriatrics, China Medical University First Hospital, Shenyang, China
| | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristen Temnyk
- Biomedical Engineering Department, Cal Poly, San Luis Obispo, California, USA
| | - Tiffany W Shen
- Biomedical Engineering Department, Cal Poly, San Luis Obispo, California, USA
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Ding YH, Abbasi M, Michalak G, Leng S, Dai D, Fitzgerald S, Kadirvel R, Kallmes DF, Brinjikji W. Characterization of thrombus composition with multimodality CT-based imaging: an in-vitro study. J Neurointerv Surg 2020; 13:738-740. [PMID: 33115814 DOI: 10.1136/neurintsurg-2020-016799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND CT is the most commonly used imaging modality for acute ischemic stroke evaluation. There is growing interest to use pre-operative imaging to characterize clot composition in stroke. We performed an in-vitro study examining the ability of various CT techniques in differentiation between different clot types. METHODS Five clot types with varying fibrin and red blood cells (RBCs) densities (5% RBC and 95% fibrin; 25% RBC and 75% fibrin; 50% RBC and 50% fibrin; 75% RBC and 25% fibrin; 95% RBC and 5% fibrin) were prepared and scanned using various CT scanning protocols (single-energy, dual-energy, photon-counting detector CT, mixed images, and virtual monoenergetic images). Martius Scarlett Blue trichrome staining was performed to confirm the composition of each clot. Mean CT values of each type of clot under different scanning protocol were calculated and compared. RESULTS Mean CT values of the CT numbers in the five clot specimens for 5%, 25%, and 50% RBC clot were similar across modalities, and increased significantly for 75% and 95% RBC clots (P<0.0001). Mean CT values are highest in the Mono +50 keV images in each type of clot, and they were also significantly higher than all other imaging protocols (P<0.001). Dual-energy CT with Mono +50 keV images showed the greatest difference between attenuation in each type of clot. CONCLUSION Mono +50 keV dual-energy CT scan may be helpful for differentiating between RBC-rich and fibrin-rich thrombi seen in large-vessel occlusion patients.
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Affiliation(s)
- Yong-Hong Ding
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seán Fitzgerald
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Ram Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA .,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Zha ZQ, Li R, Hu MJ, Dai D, Song L, Huang F, Liu ZR. [Analysis on the relationship between smoking status and the onset age of onset and the direct medical expenditure expenses of gastric cancer patients]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:1482-1486. [PMID: 33076603 DOI: 10.3760/cma.j.cn112338-20190927-00706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the relationship between smoking status and the onset age of stomach cancer patients and estimate the patients' direct medical cost burden of stomach cancer due to smoking in Anhui province. Methods: The information about the primary stomach cancer patients and their direct treatment expenditures in 10 cancer-registered areas in Anhui were collected in 2017. The association between smoking status and the age of onset of stomach cancer patients was analyzed by univariate regression and multivariate logistic regression models. The median and smoking-attributed risk method was used to describe the direct treatment expenditure of stomach cancer patients in Anhui due to smoking. Results: A total of 736 patients with stomach cancer were analyzed in this study. Univariate regression analysis showed that rural household registration (t=2.091, P=0.037), smoking (t=-2.357, P=0.001 9) and alcohol consumption (t=-2.036, P=0.042) were related to the age of onset of stomach cancer. After adjusting for gender, alcohol consumption, body mass index and household registration type, the risk of early stomach cancer in people who quitted smoking cessation was lower than that in smokers (OR=0.36, 95%CI: 0.17-0.75). The total direct medical cost burden of 736 newly diagnosed stomach cancer patients was 6.939 6 million RMB. The direct medical expenditure in stomach cancer patients who had smoking behavior was higher than that in stomach cancer patients who quitted smoking and never smoked. Conclusions: Smoking is one of the risk factors for the earlier onset of stomach cancer in Anhui. It is necessary to strengthen tobacco control to reduce the economic burden of patients with stomach cancer.
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Affiliation(s)
- Z Q Zha
- Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - R Li
- Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - M J Hu
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei 230032, China
| | - D Dai
- Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - L Song
- Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - F Huang
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei 230032, China
| | - Z R Liu
- Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
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Xu W, Xing XY, He Q, Dai D, Li R, Xu JQ, Chen YJ, Liu ZR. [A cross-sectional study on the prevalence and related factors of dyslipidemia among adults in Anhui province, in 2015]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:195-200. [PMID: 32164129 DOI: 10.3760/cma.j.issn.0254-6450.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Based on the data of chronic diseases and nutrition surveillance among Chinese adults in 2015, dyslipidemia and related factors were analyzed. Methods: Multi-stage stratified cluster random sampling was used to select participants who were aged 18 and over, with questionnaire survey and related measurements conducted. Prevalence rates of dyslipidemia among participants by different characteristics and influencing factors were analyzed, using the method of complex weighting and post-weighted stratification. Results: In all, 7 404 participants were included. The overall prevalence of dyslipidemia was 30.5% among the adults. The overall prevalence of dyslipidemia were 36.5% in males and 24.4% in females (P<0.05). The prevalence rates of hypercholesterolemia, hypertriglyceridemia, high LDL-C, and low HDL-C were 3.7%, 12.2%, 5.3%, and 19.4%, respectively. Results from the multivariate logistic regression model analysis showed that age (OR=1.009, 95%CI: 1.000-1.018), female (OR=0.501, 95%CI: 0.397-0.632), College degree or above (OR=1.728, 95%CI: 1.257-2.374), alcohol consumption 3 (OR=0.711, 95%CI: 0.536-0.943), central obesity (OR=1.868, 95%CI: 1.547-2.257), BMI (OR=1.141, 95%CI: 1.098-1.186), hypertension (OR=1.259, 95%CI: 1.077-1.473) and diabetes (OR=2.025, 95%CI: 1.446-2.835) were influencing factors on dyslipidemia. Conclusions: The prevalence of dyslipidemia seemed high among adults in Anhui. Risk factors should be closely monitored and under control, including those people with unhealthy lifestyles or being overweight, obesity, hypertensive and diabetic.
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Affiliation(s)
- W Xu
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - X Y Xing
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - Q He
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - D Dai
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - R Li
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - J Q Xu
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - Y J Chen
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
| | - Z R Liu
- Department of Chronic and Non-communicable Disease Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
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Tian YM, Jing L, Lin M, Du Z, Yan H, Liu S, Sun Q, Dai D, Shi L, Xing LY. [Prevalence and risk factors of ischemic stroke in rural areas of Liaoning province]. Zhonghua Xin Xue Guan Bing Za Zhi 2020; 48:148-153. [PMID: 32135616 DOI: 10.3760/cma.j.issn.0253-3758.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the prevalence and risk factors of ischemic stroke in rural areas of Liaoning province. Methods: The study was a cross-sectional survey. From September 2017 to May 2018, a total of 10 926 rural residents aged ≥40 years were investigated in Chaoyang county, Lingyuan, Liaoyang county and Donggang city of Liaoning province. The investigation included questionnaire survey, physical examination and laboratory examination.Univariate and multivariate logistic regression models were used to analyze the risk factors of ischemic stroke. Results: The prevalence of ischemic stroke in the rural areas of Liaoning province was 5.51% (602/10 926), and the standardized prevalence rate was 4.04%. The standardized prevalence rate of male (5.05%) is higher than that of female (3.44%). The prevalence of ischemic stroke increased with age in both males (P<0.01) and females (P<0.01). Multivariate logistic regression analysis showed that age increase(compared with 40-49 years old group, 50-59 years old, OR=2.08, 95%CI 1.31-3.30, P=0.02; 60-69 years old, OR=3.90, 95%CI 2.51-6.05, P<0.01; 70-79 years old, OR=5.32, 95%CI 3.37-8.34, P<0.01; ≥80 years old, OR=3.64, 95%CI 2.00-6.62, P<0.01), male(OR=2.35, 95%CI 1.95-2.84, P<0.01),family history of stroke(OR=2.18, 95%CI 1.83-2.60, P<0.01),coronary heart disease (OR=2.01, 95%CI 1.52-2.66, P<0.01), hypertension (OR=2.82, 95%CI 2.21-3.60, P<0.01), diabetes mellitus (OR=1.36, 95%CI 1.11-1.67, P=0.03) and overweight/obese (OR=1.22, 95%CI 1.02-1.47, P=0.03) were the major risk factors of ischemic stroke. Conclusions: The prevalence of ischemic stroke in rural areas of Liaoning province is high. Age, male, family history of stroke, coronary heart disease, hypertension, diabetes mellitus, overweight/obesity are the risk factors of ischemic stroke in rural areas of Liaoning province.
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Affiliation(s)
- Y M Tian
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang 110005, China
| | - L Jing
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang 110005, China
| | - M Lin
- Department of Cardiology, Benxi Central Hospital of Liaoning Province, Benxi 117000, China
| | - Z Du
- Department of Cardiology, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - H Yan
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang 110005, China
| | - S Liu
- Department of Cardiology, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Q Sun
- Liaoning Chaoyang Center for Disease Control and Prevention, Chaoyang 122000, China
| | - D Dai
- Liaoning Dandong Center for Disease Control and Prevention, Dandong 118000, China
| | - L Shi
- Liaoning Liaoyang Center for Disease Control and Prevention, Liaoyang 111000, China
| | - L Y Xing
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang 110005, China
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Mereuta OM, Fitzgerald S, Abbasi M, Dai D, Kadirvel R, Kallmes DF, Doyle KM, Brinjikji W. Abstract WP268: Von Willebrand Factor Expression in Various Subtypes of Acute Ischemic Stroke. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Von Willebrand factor (VWF) is a key component of acute ischemic stroke (AIS) thrombi. The aim of our prospective study was to investigate the immunohistochemical expression of VWF in clots and to evaluate whether VWF is associated with certain subtypes of AIS.
Methods:
VWF immunostaining was performed on 79 thrombi collected as part of the multi-center Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) registry. The cases were classified according to TOAST criteria. The VWF expression was quantified using Orbit Image Analysis (www.Orbit.bio) machine learning software. IBM SPSS statistics 25 was used to assess the relationship between the VWF levels and different etiology subtypes.
Results:
A cardioembolic stroke was defined in 39 cases (49.4%) whereas an atherosclerotic origin was identified in 13 patients (16.5%). Other causes accounted for 12 cases (15.1%). Unknown etiology was reported in 15 cases (19%). The mean VWF content in the clots was 12.8%. According to the Mann-Whitney U-test, the level of VWF was significantly higher in the cases with unknown etiology compared to cardioembolic origin (p=0.044). We found also that patients with unknown etiology of stroke had higher VWF expression as compared to the other two subtypes, although this difference was not statistically significant.
Conclusions:
Among the patients with ischemic stroke included in this study, the VWF expression was significantly increased in those with unknown etiology compared to the group with cardioembolic stroke. Our finding provides new insights into clot composition in cryptogenic stroke and may influence the treatment and secondary prevention in these cases.
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Affiliation(s)
| | | | | | | | | | | | - Karen M Doyle
- Physiology, National Univ of Ireland Galway, Galway, Ireland
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Fitzgerald S, Dai D, Rizvi A, Doyle KM, Kadirvel R, Kallmes DF, Jaspersen AL, Christensen TA, Brinjikji W. Abstract TP214: 3D-Electron Microscopy for the Analysis of the Microstructure of Acute Ischemic Stroke Clots. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Characterization of acute ischemic stroke thrombi has typically focused on the two dimensional (2D) histological characterization of the thrombus. Little is known about the three dimensional (3D) structure of these occlusive thrombi. Electron Microscopy (EM) can be used to obtain 3D information about the organization of clot components. Individual structures can be segmented and qualitative and quantitative information obtained from the clots.
Methods:
Following IRB approval from Mayo Clinic, acute ischemic stroke clot samples were collected from 10 patients treated at Mayo Clinic. Samples were immediately fixed in fresh modified Trumps fixative solution. A representative fragment of clot was taken and split longitudinally into two pieces; one piece was sent for 3D-EM analysis and the other for histological processing and analysis. Hematoxylin and eosin stain (H&E) and Martius Scarlett Blue (MSB) histological stains were used for conventional histopathology evaluation and components analysis. Immunohistochemical (IHC) staining using anti-CD42b (Platelets) was applied to confirm the presence of platelets in each clot. Serial block-face scanning electron microscopy was used to generate high-resolution three-dimensional images.
Results:
The 2D morphological features of the clot were identified using H&E, MSB and anti-CD42b staining. The 3D organization of thrombi varies greatly, both within and between clots depending on the constituents. Red Blood Cell-rich areas are mainly composed of Red Blood Cells packaged tightly together, with a small number of Fibrin strands interwoven between the cells. Fibrin-rich areas are characterized by dense networks of fibrin strands along with platelets and White Blood Cells with some sparse Red Blood Cells present. Platelet-rich areas are composed of large volumes of de-granulated platelets, some fibrin stands and white blood cells and an absence of Red Blood Cells.
Conclusions:
3D electron microscopy can provide important information on the organization of components within thrombi. This could provide key information on the age and etiology of the thrombus. In addition, it may help to inform thrombolytic treatment and medical device design.
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Affiliation(s)
| | - Daying Dai
- Radiology, Mayo Clinic Rochester, Rochester, MN
| | - Asim Rizvi
- Radiology, Mayo Clinic Rochester, Rochester, MN
| | - Karen M Doyle
- CÚRAM – Cntr for Rsch in Med Devices, Galway, Ireland
| | | | | | - Adam L Jaspersen
- Microscopy and Cell Analysis, Mayo Clinic Rochester, Rochester, MN
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Fitzgerald S, Dai D, Douglas AS, Mereuta OM, Caracena T, Rizvi A, Kaufmann EC, Jensen TE, Klingele C, Kadirvel R, Kallmes DF, Doyle KM, Brinjikji W. Abstract WP108: Novel Human Acute Ischemic Stroke Blood Clot Analogues for
in-vitro
Testing. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Previous studies have successfully created blood clot analogues for
In-vitro
testing using animal blood. Blood components vary greatly among species and thus, creating clot analogues with human blood is likely a more accurate representation of thrombi formed in the human vasculature. We present a novel method of creating clot analogues from human blood and platelets that mimic the process by which clots form
In-vivo
.
Methods:
Following IRB approval from Mayo Clinic, human whole blood and platelets donations were obtained from the Blood Transfusion service. The whole blood was centrifuged at 1,200RPM for 20 minutes to separate it into its constituents. Plasma was removed and the remaining Red Blood Cells and Buffy Coat were mixed together by inverting. A total of 12 clot analogues were created with varying concentrations of components; Red Blood cells/Buffy Coat, Plasma and Platelets. Thrombin was added first to stimulate platelets activation for a total of 5 mins whilst continuously mixing by inversion. The RBC/WBC mixture was added next followed by CaCl2. The mixture was then quickly drawn into a 3cc syringe and spun overnight at 20RPM at room temperature to mimic dynamic flow conditions. Macro-photographs were taken to display the variation in texture and color between different clot analogue types. The clots were then fixed in 10% neutral buffered formalin for 24 hours prior to being processed. Histopathological analysis was performed using Hematoxylin and Eosin (H&E) and Martius Scarlet Blue (MSB) staining to confirm clot composition.
Results:
Red Blood cell-rich, Fibrin-rich, Platelet-rich and mixed clot analogues that accurately mimic clots retrieved from Acute Ischemic Stroke Patients were created. The range of histopathological compositions of the clot analogues is similar to that of the clinical samples.
Conclusions:
The addition and activation of platelets is key to creating accurate clot analogues for
In-vitro
testing. Spinning the clots is important to prevent natural sedimentation and mimic the
In-vivo
situation.
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Affiliation(s)
| | - Daying Dai
- Radiology, Mayo Clinic Rochester, Rochester, MN
| | - Andrew S Douglas
- Physiology, CÚRAM – Cntr for Rsch in Med Devices, Galway, Ireland
| | - Oana M Mereuta
- Physiology, CÚRAM – Cntr for Rsch in Med Devices, Galway, Ireland
| | | | - Asim Rizvi
- Radiology, Mayo Clinic Rochester, Rochester, MN
| | | | | | | | | | | | - Karen M Doyle
- Physiology, CÚRAM – Cntr for Rsch in Med Devices, Galway, Ireland
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Mapili K, Pieper KJ, Dai D, Pruden A, Edwards MA, Tang M, Rhoads WJ. Legionella pneumophila
occurrence in drinking water supplied by private wells. Lett Appl Microbiol 2020; 70:232-240. [DOI: 10.1111/lam.13273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- K. Mapili
- Virginia Tech, Civil and Environmental Engineering Blacksburg VA USA
| | - K. J. Pieper
- Northeastern University, Civil and Environmental Engineering Snell Engineering Center Boston MA USA
| | - D. Dai
- Virginia Tech, Civil and Environmental Engineering Blacksburg VA USA
| | - A. Pruden
- Virginia Tech, Civil and Environmental Engineering Blacksburg VA USA
| | - M. A. Edwards
- Virginia Tech, Civil and Environmental Engineering Blacksburg VA USA
| | - M. Tang
- Oak Ridge Institute for Science and Education (ORISE) at Environmental Protection Agency Cincinnati OH USA
| | - W. J. Rhoads
- Virginia Tech, Civil and Environmental Engineering Blacksburg VA USA
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Fitzgerald S, Wang S, Dai D, Murphree DH, Pandit A, Douglas A, Rizvi A, Kadirvel R, Gilvarry M, McCarthy R, Stritt M, Gounis MJ, Brinjikji W, Kallmes DF, Doyle KM. Orbit image analysis machine learning software can be used for the histological quantification of acute ischemic stroke blood clots. PLoS One 2019; 14:e0225841. [PMID: 31805096 PMCID: PMC6894878 DOI: 10.1371/journal.pone.0225841] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
Our aim was to assess the utility of a novel machine learning software (Orbit Image Analysis) in the histological quantification of acute ischemic stroke (AIS) clots. We analyzed 50 AIS blood clots retrieved using mechanical thrombectomy procedures. Following H&E staining, quantification of clot components was performed by two different methods: a pathologist using a reference standard method (Adobe Photoshop CC) and an experienced researcher using Orbit Image Analysis. Following quantification, the clots were categorized into 3 types: RBC dominant (≥60% RBCs), Mixed and Fibrin dominant (≥60% Fibrin). Correlations between clot composition and Hounsfield Units density on Computed Tomography (CT) were assessed. There was a significant correlation between the components of clots as quantified by the Orbit Image Analysis algorithm and the reference standard approach (ρ = 0.944**, p < 0.001, n = 150). A significant relationship was found between clot composition (RBC-Rich, Mixed, Fibrin-Rich) and the presence of a Hyperdense artery sign using the algorithmic method (X2(2) = 6.712, p = 0.035*) but not using the reference standard method (X2(2) = 3.924, p = 0.141). Orbit Image Analysis machine learning software can be used for the histological quantification of AIS clots, reproducibly generating composition analyses similar to current reference standard methods.
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Affiliation(s)
- Seán Fitzgerald
- CÚRAM–Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Shunli Wang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Pathology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dennis H. Murphree
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Abhay Pandit
- CÚRAM–Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Andrew Douglas
- CÚRAM–Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Asim Rizvi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | | | | | | | - Matthew J. Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Karen M. Doyle
- CÚRAM–Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
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Dai D, Huang H, Liu J. Comparison of long-term oncologic outcomes between laparoscopy and laparotomy for stage Ia1-Ib3 cervical cancer: A matched cohort study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz426.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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47
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Benson JC, Fitzgerald ST, Kadirvel R, Johnson C, Dai D, Karen D, Kallmes DF, Brinjikji W. Clot permeability and histopathology: is a clot's perviousness on CT imaging correlated with its histologic composition? J Neurointerv Surg 2019; 12:38-42. [PMID: 31239329 DOI: 10.1136/neurintsurg-2019-014979] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Clot perviousness in large vessel occlusion has been shown to be associated with improved recanalization outcomes with mechanical thrombectomy and intravenous thrombolysis. OBJECTIVE To evaluate the association between clot perviousness based on thrombus attenuation increase (TAI) on CT, and histologic composition of clots in acute ischemic stroke (AIS). METHODS A retrospective review was completed of patients with AIS secondary to large vessel occlusion, non-contrast CT (NCCT) and CT angiography (CTA) images, and histologic analysis of the retrieved clot. TAI was measured by subtracting clot attenuation on NCCT from the attenuation on CTA. Up to 3 regions of interest (ROIs) were evaluated on each clot; the average attenuation was used for analysis if multiple ROIs were assessed. Pervious clots were defined as TAI ≥10 Hounsfield units (HUs); impervious clots had TAI <10 HU. Histopathologic analyses of clots were assessed for relative compositions of red blood cells (RBCs), white blood cells (WBCs), fibrin, and platelets/other. RESULTS 57 patients were included. Pervious clots were more likely to be RBC rich (p=0.04); impervious clots were more likely to be fibrin and WBC rich (p=0.01 for both). Pervious clots also had greater RBC density than impervious clots (49.8% and 33.0%, respectively; p=0.006); fibrin density of pervious clots was lower than that of impervious clots (17.8% and 23.2%, respectively; p=0.02). CONCLUSION Clot perviousness, assessed on NCCT and CTA imaging, is associated with higher RBC density and lower fibrin density, offering a possible explanation for the higher rates of successful thrombectomy and favorable clinical outcome seen in such patients.
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Affiliation(s)
| | - Sean T Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,CURAM- Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | | | - Collin Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Doyle Karen
- CURAM- Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - David F Kallmes
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
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Arango-Argoty GA, Dai D, Pruden A, Vikesland P, Heath LS, Zhang L. NanoARG: a web service for detecting and contextualizing antimicrobial resistance genes from nanopore-derived metagenomes. Microbiome 2019; 7:88. [PMID: 31174603 PMCID: PMC6555988 DOI: 10.1186/s40168-019-0703-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/28/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Direct and indirect selection pressures imposed by antibiotics and co-selective agents and horizontal gene transfer are fundamental drivers of the evolution and spread of antibiotic resistance. Therefore, effective environmental monitoring tools should ideally capture not only antibiotic resistance genes (ARGs), but also mobile genetic elements (MGEs) and indicators of co-selective forces, such as metal resistance genes (MRGs). A major challenge towards characterizing the potential human health risk of antibiotic resistance is the ability to identify ARG-carrying microorganisms, of which human pathogens are arguably of greatest risk. Historically, short reads produced by next-generation sequencing technologies have hampered confidence in assemblies for achieving these purposes. RESULTS Here, we introduce NanoARG, an online computational resource that takes advantage of the long reads produced by nanopore sequencing technology. Specifically, long nanopore reads enable identification of ARGs in the context of relevant neighboring genes, thus providing valuable insight into mobility, co-selection, and pathogenicity. NanoARG was applied to study a variety of nanopore sequencing data to demonstrate its functionality. NanoARG was further validated through characterizing its ability to correctly identify ARGs in sequences of varying lengths and a range of sequencing error rates. CONCLUSIONS NanoARG allows users to upload sequence data online and provides various means to analyze and visualize the data, including quantitative and simultaneous profiling of ARGs, MRGs, MGEs, and putative pathogens. A user-friendly interface allows users the analysis of long DNA sequences (including assembled contigs), facilitating data processing, analysis, and visualization. NanoARG is publicly available and freely accessible at https://bench.cs.vt.edu/nanoarg .
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Affiliation(s)
| | - D. Dai
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA USA
| | - A. Pruden
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA USA
| | - P. Vikesland
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA USA
| | - L. S. Heath
- Department of Computer Science, Virginia Tech, Blacksburg, VA USA
| | - L. Zhang
- Department of Computer Science, Virginia Tech, Blacksburg, VA USA
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Fitzgerald S, Mereuta OM, Doyle KM, Dai D, Kadirvel R, Kallmes DF, Brinjikji W. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome. J Neurosurg Sci 2019; 63:292-300. [PMID: 30514073 PMCID: PMC8693286 DOI: 10.23736/s0390-5616.18.04629-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mechanical thrombectomy has become the stand of care for patients with large vessel occlusions, yet major improvements in thrombectomy speed, efficacy, and completeness can still be achieved. High rates of clot fragmentation and failure to remove the clot resulting in poor neurological outcomes suggest that in order to further advance the field of stroke intervention we must turn our attention towards understanding the science of clot. Accurately identifying the composition of the occlusive clot prior to intervention could significantly influence the success of the revascularization strategy used to treat them. Numerous features of thromboemboli could be studied and characterized, including quantitative histomorphometry and diagnostic imaging characteristics. Each of these features might logically predict superior thrombectomy outcomes with one device or another. This article aims to review the current literature on histopathological composition of acute ischemic stroke clots, with a particular focus on the correlation between clot composition and diagnostic imaging, stroke etiology and revascularization outcomes.
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Affiliation(s)
- Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Oana M Mereuta
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Karen M Doyle
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA -
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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50
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Fitzgerald S, Dai D, Wang S, Douglas A, Kadirvel R, Layton KF, Thacker IC, Gounis MJ, Chueh JY, Puri AS, Almekhlafi M, Demchuk AM, Hanel RA, Sauvageau E, Aghaebrahim A, Yoo AJ, Kvamme P, M Pereira V, Kayan Y, Delgado Almandoz JE, Nogueira RG, Rabinstein AA, Kallmes DF, Doyle KM, Brinjikji W. Platelet-Rich Emboli in Cerebral Large Vessel Occlusion Are Associated With a Large Artery Atherosclerosis Source. Stroke 2019; 50:1907-1910. [PMID: 31138084 DOI: 10.1161/strokeaha.118.024543] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background and Purpose- Nearly 30% of large vessel occlusion acute ischemic stroke clots are from an unknown source. We assessed histological clot composition in a series of patients with large vessel occlusion and investigated correlations between clot composition and stroke pathogenesis. Methods- As part of the multi-institutional STRIP registry (Stroke Thromboembolism Registry of Imaging and Pathology), consecutive emboli retrieved during mechanical thrombectomy were stained using Martius Scarlett Blue and analyzed using machine learning software. We assessed proportions of red blood cells, fibrin, platelets, and white blood cells. Correlations between clot components and stroke pathogenesis (large artery atherosclerosis, cardioembolism, and stroke of undetermined pathogenesis) were assessed using SPSS22. Results- One hundred five patients were included. The proportion of platelet-rich clots (55.0% versus 21.2%; P=0.005) and percentage of platelet content (22.1±4.2% versus 13.9±14.2%; P=0.03) was significantly higher in the large artery atherosclerosis group compared with the cardioembolic group. The proportion of platelet-rich clots (50.0% versus 21.2%; P=0.024) was also significantly higher in the cryptogenic group compared with cardioembolic cases. Large artery atherosclerosis and cryptogenic cases had a similar proportion of platelet-rich clots (55.0% versus 50.0%; P=0.636). There was no significant difference between stroke pathogenesis and the other major clot components. Conclusions- High platelet content of emboli is associated with a large artery atherosclerosis etiology of large vessel occlusion.
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Affiliation(s)
- Seán Fitzgerald
- From the Department of Radiology, Mayo Clinic, Rochester, MN (S.F., D.D., S.W., R.K., D.F.K., W.B.).,Department of Physiology, CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Ireland (S.F., A.D., K.M.D.)
| | - Daying Dai
- From the Department of Radiology, Mayo Clinic, Rochester, MN (S.F., D.D., S.W., R.K., D.F.K., W.B.)
| | - Shunli Wang
- From the Department of Radiology, Mayo Clinic, Rochester, MN (S.F., D.D., S.W., R.K., D.F.K., W.B.)
| | - Andrew Douglas
- Department of Physiology, CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Ireland (S.F., A.D., K.M.D.)
| | - Ramanathan Kadirvel
- From the Department of Radiology, Mayo Clinic, Rochester, MN (S.F., D.D., S.W., R.K., D.F.K., W.B.)
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, TX (K.F.L., I.C.T.)
| | - Ike C Thacker
- Department of Radiology, Baylor University Medical Center, Dallas, TX (K.F.L., I.C.T.)
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester (M.J.G., J.-Y.C., A.S.P.)
| | - Ju-Yu Chueh
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester (M.J.G., J.-Y.C., A.S.P.)
| | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester (M.J.G., J.-Y.C., A.S.P.)
| | - Mohammed Almekhlafi
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (M.A., A.M.D.)
| | - Andrew M Demchuk
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (M.A., A.M.D.)
| | - Ricardo A Hanel
- Department of Radiology, Stroke and Cerebrovascular Surgery, Lyerly Neurosurgery/Baptist Neurological Institute, Jacksonville, FL (R.A.H., E.S., A.A.)
| | - Eric Sauvageau
- Department of Radiology, Stroke and Cerebrovascular Surgery, Lyerly Neurosurgery/Baptist Neurological Institute, Jacksonville, FL (R.A.H., E.S., A.A.)
| | - Amin Aghaebrahim
- Department of Radiology, Stroke and Cerebrovascular Surgery, Lyerly Neurosurgery/Baptist Neurological Institute, Jacksonville, FL (R.A.H., E.S., A.A.)
| | - Albert J Yoo
- Department of Radiology, Texas Stroke Institute, Dallas-Fort Worth (A.J.Y.)
| | - Peter Kvamme
- Department of Radiology, University of Tennessee Medical Center, Knoxville (P.K.)
| | - Vitor M Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, Ontario, Canada (V.M.P.)
| | - Yasha Kayan
- Department of Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN (Y.K., J.E.D.A.)
| | - Josser E Delgado Almandoz
- Department of Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN (Y.K., J.E.D.A.)
| | - Raul G Nogueira
- Department of Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University, Atlanta, GA (R.G.N.)
| | | | - David F Kallmes
- From the Department of Radiology, Mayo Clinic, Rochester, MN (S.F., D.D., S.W., R.K., D.F.K., W.B.)
| | - Karen M Doyle
- Department of Physiology, CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Ireland (S.F., A.D., K.M.D.)
| | - Waleed Brinjikji
- From the Department of Radiology, Mayo Clinic, Rochester, MN (S.F., D.D., S.W., R.K., D.F.K., W.B.)
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