Clot Histopathology in Ischemic Stroke with Infective Endocarditis.
Clot histopathology
Endovascular thrombectomy
Infective endocarditis
Ischemic stroke
Journal
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques
ISSN: 0317-1671
Titre abrégé: Can J Neurol Sci
Pays: England
ID NLM: 0415227
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
pubmed:
15
3
2019
medline:
9
4
2020
entrez:
15
3
2019
Statut:
ppublish
Résumé
Endovascular thrombectomy (EVT) has shown efficacy in acute ischemic stroke (AIS) patients with infective endocarditis (IE). The possibility to undertake advanced histopathological clot analysis following EVT offers a new avenue to establish the etiological basis of the stroke - which is often labelled "cryptogenic." In this paper, we present our findings from four consecutive patients with IE who underwent EVT following an AIS at our tertiary referral comprehensive stroke centre. Comprehensive histopathological analysis of clot retrieved after EVT, including morphology, was undertaken. The consistent observation was the presence of dense paucicellular fibrinoid material mixed/interspersed with clusters of bacterial cocci. This clot morphology may be specific to septic embolus due to IE unlike incidental bacteraemia and could possibly explain the refractoriness of such clots to systemic thrombolysis. Detailed morphological and histopathological analysis of EVT-retrieved clots including Gram staining can assist in etiological classification of the clot. Understanding the composition of the clot may be of clinical value in early diagnostics and mapping treatment planning in IE.
Sections du résumé
BACKGROUND
Endovascular thrombectomy (EVT) has shown efficacy in acute ischemic stroke (AIS) patients with infective endocarditis (IE). The possibility to undertake advanced histopathological clot analysis following EVT offers a new avenue to establish the etiological basis of the stroke - which is often labelled "cryptogenic." In this paper, we present our findings from four consecutive patients with IE who underwent EVT following an AIS at our tertiary referral comprehensive stroke centre.
METHODS
Comprehensive histopathological analysis of clot retrieved after EVT, including morphology, was undertaken.
RESULTS
The consistent observation was the presence of dense paucicellular fibrinoid material mixed/interspersed with clusters of bacterial cocci. This clot morphology may be specific to septic embolus due to IE unlike incidental bacteraemia and could possibly explain the refractoriness of such clots to systemic thrombolysis.
CONCLUSION
Detailed morphological and histopathological analysis of EVT-retrieved clots including Gram staining can assist in etiological classification of the clot. Understanding the composition of the clot may be of clinical value in early diagnostics and mapping treatment planning in IE.
Identifiants
pubmed: 30867075
pii: S0317167119000088
doi: 10.1017/cjn.2019.8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM