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

UMMS Affiliation

Department of Radiology, New England Center for Stroke Research

Publication Date


Document Type



Cardiovascular Diseases | Nervous System Diseases | Neurology | Neurosurgery | Radiology


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.


Clot composition, Stroke, Thrombectomy, r-TPA

DOI of Published Version



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 Apr;31(4):106376. doi: 10.1016/j.jstrokecerebrovasdis.2022.106376. Epub 2022 Feb 17. PMID: 35183984. Link to article on publisher's site

Journal/Book/Conference Title

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association


Full author list omitted for brevity. For the full list of authors, see article.

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