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Clot Histopathology in Ischemic Stroke with Infective Endocarditis

  • Sonu Bhaskar (a1) (a2) (a3) (a4) (a5) (a6), Jawad Saab (a7), Cecilia Cappelen-Smith (a1) (a8) (a4), Murray Killingsworth (a2) (a8) (a7), Xiao Juan Wu (a7), Andrew Cheung (a4) (a9) (a10), Nathan Manning (a4) (a9) (a10) (a11), Patrick Aouad (a1) (a12), Alan McDougall (a1) (a8) (a4), Suzanne Hodgkinson (a1) (a8) (a4) and Dennis Cordato (a1) (a2) (a8) (a4)...

Abstract:

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.

Recourir à l’histopathologie des caillots de patients victimes d’accidents ischémiques et atteints d’endocardite infectieuse. Contexte: La thrombectomie endovasculaire (TEV) s’est révélée efficace dans le cas de patients aux prises avec une endocardite infectieuse qui ont été victimes d’accidents ischémiques cérébraux aigus. La possibilité de procéder à des analyses histopathologiques avancées de leurs caillots à la suite d’une TEV offre désormais une avenue inédite permettant d’établir les bases étiologiques d’un AVC, avenue souvent qualifiée de « cryptogénique ». Dans cet article, nous voulons présenter les résultats que nous avons obtenus auprès de quatre patients qui étaient atteints d’endocardite infectieuse et qui avaient subi une TEV à la suite d’un accident ischémique cérébral aigu. Fait à souligner, ces patients ont été vus un à la suite de l’autre après avoir été adressés à notre centre tertiaire complet de prise en charge des AVC (tertiary referral comprehensive stroke centre). Méthodes: Nous avons procédé à une analyse histopathologique exhaustive de caillots ayant été récupérés consécutivement à une TEV, notamment leur aspect morphologique. Résultats: De façon régulière, nous avons pu observer la présence de substance paucicellulaire fibrinoïde dense mélangée ou alternant avec des bactéries de forme sphérique regroupées en grappes. À la différence des bactériémies indirectes, il se pourrait que cette caractéristique morphologique se rapporte spécifiquement à une embolie septique attribuable en retour à une endocardite infectieuse. Cela pourrait expliquer éventuellement la réaction réfractaire de tels caillots à une thrombolyse effectuée systématiquement. Conclusion: Il est donc possible, si l’on veut procéder à une classification étiologique de caillots, de bénéficier d’analyses morphologiques et histopathologiques de caillots récupérés à la suite d’une TEV, ce qui inclut le recours à la technique de coloration de Gram. Il se pourrait ainsi que la compréhension de la composition d’un caillot soit d’une utilité clinique lors de diagnostics précoces d’endocardite infectieuse et aussi dans le but de planifier et d’établir un traitement.

Copyright

Corresponding author

Correspondence to: Sonu Bhaskar and Dennis Cordato, Department of Neurology & Neurophysiology, Liverpool Hospital, Level 1, Neurophysiology; Clinical Sciences Building, Elizabeth St, Liverpool Hospital, Sydney, NSW 2170, Australia. Emails: Sonu.Bhaskar@health.nsw.gov.au; Dennis.Cordato@health.nsw.gov.au

References

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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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