Background: Only few studies have investigated the relationship between the histopathology of retrieved thrombi and clinical outcomes. This study aimed to evaluate thrombus composition and its association with clinical, laboratory, and neurointerventional findings in patients treated by mechanical thrombectomy due to acute large vessel occlusion. Methods: At our institution, 79 patients were treated by mechanical thrombectomy using a stent retriever and/or aspiration catheter between August 2015 and August 2016. The retrieved thrombi were quantitatively analyzed to quantify red blood cells, white blood cells, and fibrin by area. We divided the patients into two groups – a fibrin-rich group and an erythrocyte-rich group – based on the predominant composition in the thrombus. The groups were compared for imaging, clinical, and neurointerventional data. Results: The retrieved thrombi from 43 patients with acute stroke from internal carotid artery, middle cerebral artery, or basilar artery occlusion were histologically analyzed. Erythrocyte-rich thrombi were present in 18 cases, while fibrin-rich thrombi were present in 25 cases. A cardioembolic etiology was significantly more prevalent among the patients with fibrin-rich thrombi than among those with erythrocyte-rich thrombi. Attenuation of thrombus density as shown on computed tomography images was greater in patients with erythrocyte-rich thrombi than in those with fibrin-rich thrombi. All other clinical and laboratory characteristics remained the same. Patients with erythrocyte-rich thrombi had a smaller number of recanalization maneuvers, shorter procedure times, a shorter time interval between arrival and recanalization, and a higher percentage of stent retrievers in the final recanalization procedure. The occluded vessels did not differ significantly. Conclusions: In this study, erythrocyte-rich thrombus was associated with noncardioembolic etiology, higher thrombus density, and reduced procedure time.
The author has shown the effect of various inorganic ions on the polymorphic crystallization of calcium carbonate from a bicarbonate solution. No definite conclusion regarding the mechanism to give calcite, aragonite or vaterite can yet be made, but these data help to give a pattern of the influence of inorganic ionic species and the concentration of the mother solution on the polymorphic crystallization of calcium carbonate. (1) Alkali chlorides in the mother solution inhibited aragonite formation and favored calcite formation. The extent of the inhibition of the aragonite formation decreases in the sequence: ammonium chloride>lithium chloride, sodium chloride>potassium chloride >rubidium chloride, >cesium chloride (sodium nitrate). (2) (a) Sodium chloride and sodium nitrate in the mother solution inhibited aragonite formation, sodium chloride more strongly than sodium nitrate, (b) With a moderate increase in the amount of sodium bicarbonate (sodium carbonate) added to the mother solution, the percentage of aragonite formation increased to a maximum. With a further increase in the amount, however, the percentage began to decrease and reached zero, (c) When sodium hydroxide was added to the mother solution, only calcite was formed. Aragonite was never formed from the solution which had made alkaline with sodium hydroxide, (d) The presence of sulfate ions favored aragonite formation. (3) (a) Magnesium ions in the mother solution favored aragonite formation very strongly. The presence of magnesium chloride in the mother solution was more favorable to aragonite formation than that of magnesium bicarbonate or magnesium sulfate. Magnesium was not co-precipitated with calcium carbonate, (b) The presence of calcium chloride in the mother solution had no effect on the crystallization. (c) With an increase in the strontium concentration in the original solution, the percentage of aragonite formation increased to a maximum (optimum strontium content: approximately 2 mg./l). The percentage began to decrease with a further increase in strontium concentration. The strontium was always entrained in calcium carbonate precipitates, even when the strontium concentration was very low. (d) The presence of a small number of barium ions in the mother solution favored calcite formation. The presence of a large number of barium ions favored vaterite formation. Even at a low concentration in the mother solution, barium was always entrapped in the precipitates.
Calcite and/or aragonite were formed from calcium bicarbonate solutions containing sodium sulfate, sodium chloride and magnesium chloride of various concentrations. Sodium, chloride and sulfate contents of synthetic calcite or aragonite were measured. Sodium and chloride ions are incorporated into aragonitic calcium carbonate more easily than into calcitic calcium carbonate, although sodium and chloride ions in the parent solution favor the forma tion of calcitic calcium carbonate. On the other hand, sulfate ions are incorporated into calcitic calcium carbonate more easily than into aragonitic calcium carbonate, although sulfate ions in the parent solution favor the formation of aragonitic calcium carbonate. Sodium content of aragonite, which is precipitated from calcium bicarbonate solution containing sodium sulfate, sodium chloride and magnesium chloride, exhibits a maximum value together with sulfate content of aragonite.
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