The diagnostic utility of routine clot analysis after endovascular thrombectomy in a patient with systemic lupus erythematosus and antiphospholipid syndrome

Valente, Michael; Saab, Jawad; Cordato, Dennis; Manning, Nathan; Cappelen‐Smith, Cecilia

doi:10.1016/j.jocn.2019.09.005

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…Immunohistopathology contributed to diagnose the embolism of a Libman-Sacks vegetation in systemic lupus erythematosus-associated endocarditis. 22 Thrombus calcification, cholesterol crystal cleft and foamy cells confirmed the aortogenic embolic stroke due to atheromatous lesion in the aortic arch. 139,140 Embolizations of carotid free-floating and carotid web thrombi were determined by assessing the clot aspect and blood cell content.…”

Section: Relationship Between Thrombus Features and Stroke Etiologymentioning

confidence: 94%

Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

et al. 2021

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Mechanical thrombectomy renders the occluding clot available for analysis. Insights into thrombus composition could help establish the stroke cause. We aimed to investigate the value of clot composition analysis as a complementary diagnostic tool in determining the etiology of large vessel occlusion (LVO) ischemic strokes (International Prospective Register of Systematic Reviews [PROSPERO] registration # CRD42020199436). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we ran searches on Medline (using the PubMed interface) and Web of Science for studies reporting analyses of thrombi retrieved from LVO stroke patients subjected to mechanical thrombectomy (January 1, 2006 to September 21, 2020). The PubMed search was updated weekly up to February 22, 2021. Reference lists of included studies and relevant reviews were hand-searched. From 1,714 identified studies, 134 eligible studies (97 cohort studies, 31 case reports, and six case series) were included in the qualitative synthesis. Physical, histopathological, biological, and microbiological analyses provided information about the gross appearance, mechanical properties, structure, and composition of the thrombi. There were non-unanimous associations of thrombus size, structure, and composition (mainly proportions of fibrin and blood formed elements) with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiology and underlying pathologies, and similarities between cryptogenic thrombi and those of known TOAST etiology. Individual thrombus analysis contributed to the diagnosis, mainly in atypical cases. Although cohort studies report an abundance of quantitative rates of main thrombus components, a definite clot signature for accurate diagnosis of stroke etiology is still lacking. Nevertheless, the qualitative examination of the embolus remains an invaluable tool for diagnosing individual cases, particularly regarding atypical stroke causes.

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Section: Relationship Between Thrombus Features and Stroke Etiologymentioning

confidence: 94%

Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

et al. 2021

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“…Other rare components that have been identified within stroke thrombi include cholesterol, collagen, vascular wall components, myxomatous material, and non-infective vegetations [ 21 , 52 , 89 , 90 ].…”

Section: Clot Componentsmentioning

confidence: 99%

Clot Morphology in Acute Ischemic Stroke Decision Making

Huang

Bhaskar

2022

IJMS

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Stroke is a leading cause of death and disability in the world, and the provision of reperfusion therapy and endovascular therapy, in particular, have revolutionized the treatment of patients with stroke and opened opportunities to look at brain clots retrieved after the procedure. The use of histopathology and molecular profiling of clots is of growing research and clinical interest. However, its clinical implications and incorporation within stroke workflows remain suboptimal. Recent studies have indicated that the study of brain clots may inform the mechanism of stroke and hence guide treatment decision-making in select groups of patients, especially patients without a defined cause or known mechanism. This article provides a comprehensive overview of various clot histopathological examinations in acute stroke-care settings, their clinical utility, and existing gaps and opportunities for further research. We also provide targeted recommendations to improve clot analysis workflow, hence standardizing its incorporation into clinical practice.

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“…In terms of interventional therapy, there are currently no clinical trials to guide clinical decision-making. Only a few active cases of arterial thrombectomy have been documented [122][123][124]. There are no reported cases of venous thrombectomy.…”

Section: Interventional Treatmentmentioning

confidence: 99%

The digestive system involvement of antiphospholipid syndrome: pathophysiology, clinical characteristics, and treatment strategies

Zhang

Han

et al. 2021

Annals of Medicine

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Antiphospholipid syndrome (APS) is an autoimmune disease mainly characterised by vascular thrombosis and pregnancy morbidity. APS has broad spectrum of clinical manifestations. The digestive system involvement of antiphospholipid syndrome is a critical but under-recognised condition. Digestive system involvement may be the result of direct (autoimmune-mediated) or indirect (thrombotic) mechanisms. Liver is the most commonly involved organ, followed by intestines, oesophagus, stomach, pancreas and spleen. This review describes possible digestive system manifestations in APS patients, and illustrates the epidemiology and possible pathophysiology of APS. The role of different treatment strategies in the management of digestive system manifestations of APS were also discussed. Key messages Antiphospholipid syndrome is a multi-organ, multi-system disease and its clinical manifestation spectrum is gradually expanding. Since the first diagnosis of APS, the clinical manifestations of digestive system have been reported successively. This narrative review describes the major digestive system manifestations of APS and illustrates the epidemiology, pathophysiology and the role of therapeutic strategies of these patients.

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The diagnostic utility of routine clot analysis after endovascular thrombectomy in a patient with systemic lupus erythematosus and antiphospholipid syndrome

Cited by 6 publications

References 8 publications

Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

Clot Morphology in Acute Ischemic Stroke Decision Making

The digestive system involvement of antiphospholipid syndrome: pathophysiology, clinical characteristics, and treatment strategies

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