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Platelet-rich emboli are associated with von Willebrand factor levels and have poorer revascularization outcomes.

Journal article
Authors Andrew Douglas
Seán Fitzgerald
Oana Madalina Mereuta
Rosanna Rossi
Sean O'Leary
Abhay Pandit
Ray McCarthy
Michael Gilvarry
Lukas Holmegaard
Margareta Abrahamsson
Mikael Jerndal
Niclas Dehlfors
Paul Brennan
Sarah Power
Alan O'Hare
Emma Griffin
David F Kallmes
Waleed Brinjikji
István Szikora
Turgut Tatlisumak
Alexandros Rentzos
John Thornton
Karen Doyle
Published in Journal of neurointerventional surgery
ISSN 1759-8486
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Language en
Subject categories Neurology


Platelets and von Willebrand factor (vWF) are key factors in thrombosis and thus are likely key components of acute ischemic stroke (AIS) emboli. We aimed to characterize platelet and vWF levels in AIS emboli and to assess associations between their expression levels and clinical and procedural information.Histopathological and immunohistochemical analysis of emboli collected as part of the multi-institutional RESTORE registry was performed. The composition of the emboli was quantified using Orbit Image Analysis machine learning software. Correlations between clot components and clinical and procedural information were assessed using the χ2 test.Ninety-one emboli samples retrieved from 63 patients were analyzed in the study. The mean platelet (CD42b) content of the clots was 33.9% and the mean vWF content of the clots was 29.8%. There was a positive correlation between platelet and vWF levels (ρ=0.564, p<0.001*, n=91). There was an inverse correlation between both platelets and vWF levels and percentage of red blood cells (RBCs) in the emboli (CD42b vs RBC: ρ=-0.535, p<0.001*, n=91; vWF vs RBC: ρ=-0.366, p<0.001*, n=91). Eighty-one percent of patients in the low platelet group had a good revascularization outcome (Thrombolysis in Cerebral Infarction 2c/3) compared with 58% in the high platelet group (χ2=5.856, p=0.016).Platelet and vWF levels in AIS emboli correlate with each other and both have an inverse relationship with RBC composition. Patients with platelet-rich clots have poorer revascularization outcomes.

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