Published Online
on June 22, 2006

A more recent version of this article appeared on August 1, 2006

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Submitted on December 18, 2005
Revised on April 4, 2006
Accepted on April 19, 2006

Analysis of Thrombi Retrieved From Cerebral Arteries of Patients With Acute Ischemic Stroke

Victor J. Marder MD^*; Dennis J. Chute MD; Sidney Starkman MD; Anna M. Abolian; Chelsea Kidwell MD; David Liebeskind MD; Bruce Ovbiagele MD; Fernando Vinuela MD; Gary Duckwiler MD; Reza Jahan MD; Paul M. Vespa MD; Scott Selco MD, PhD; Venkatakrishna Rajajee MD; Doojin Kim MD; Nerses Sanossian MD; and Jeffrey L. Saver MD

From the Departments of Medicine (V.J.M.), Neurology (S. Starkman, C.K., D.L., B.O, P.M.V., S. Selco, V.R., D.K., N.S., J.L.S.), Emergency Medicine (S. Starkman, A.M.A.), Pathology and Laboratory Medicine (D.J.C.), and Radiological Sciences (F.V., G.D., R.J.), and the Division of Neurosurgery (P.M.V.), David Geffen School of Medicine at UCLA, Los Angeles Orthopaedic Hospital, Los Angeles, Calif.

^* To whom correspondence should be addressed. E-mail: vmarder{at}laoh.ucla.edu.

Background and Purpose--Information regarding the histological structure of thromboemboli that cause acute stroke provides insight into pathogenesis and clinical management.

Methods--This report describes the histological analysis of thromboemboli retrieved by endovascular mechanical extraction from the middle cerebral artery (MCA) and intracranial carotid artery (ICA) of 25 patients with acute ischemic stroke.

Results--The large majority (75%) of thromboemboli shared architectural features of random fibrin:platelet deposits interspersed with linear collections of nucleated cells (monocytes and neutrophils) and confined erythrocyte-rich regions. This histology was prevalent with both cardioembolic and atherosclerotic sources of embolism. "Red" clots composed uniquely of erythrocytes were uncommon and observed only with incomplete extractions, and cholesterol crystals were notably absent. The histology of thromboemboli that could not be retrieved from 29 concurrent patients may be different. No thrombus >3 mm wide caused stroke limited to the MCA, and no thrombus >5 mm wide was removed from the ICA. A mycotic embolus was successfully removed in 1 case, and a small atheroma and attached intima were removed without clinical consequence from another.

Conclusions--Thromboemboli retrieved from the MCA or intracranial ICA of patients with acute ischemic stroke have similar histological components, whether derived from cardiac or arterial sources. Embolus size determines ultimate destination, those >5 mm wide likely bypassing the cerebral vessels entirely. The fibrin:platelet pattern that dominates thromboembolic structure provides a foundation for both antiplatelet and anticoagulant treatment strategies in stroke prevention.

Key words: cerebral arteries • thrombi

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