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Histologic differences between in situ and embolized carotid web thrombi: a case report
Qun Gao1,2, Shen Hu1, Ximeng Yang1
1Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
BMC Neurology
|October 14, 2021
Summary
Carotid webs (CaWs) contribute to ischemic stroke. In situ thrombi from CaWs are fibrin-rich, while embolized clots contain more red blood cells and fibrin/platelets, differing from typical stroke clots.
Area of Science:
- Neurology
- Vascular Surgery
- Pathology
Background:
- Carotid webs (CaWs) are increasingly recognized as a cause of ischemic stroke.
- Histological analysis of clots associated with CaWs, both in situ and embolized, is crucial for understanding stroke pathophysiology.
- Concurrent description of clot composition from both sources has been lacking.
Observation:
- A patient with ischemic stroke attributed to a carotid web underwent mechanical thrombectomy for middle cerebral artery thromboemboli.
- Subsequent carotid endarterectomy yielded in situ carotid web thrombi.
- Histological analysis revealed distinct compositions for embolized and in situ thrombi.
Findings:
- Embolized thrombi showed a mixed composition: 46.03% fibrin/platelet, 48.12% red blood cells (RBCs), and 5.85% white blood cells.
- In situ thrombi were predominantly fibrin (68.0%), with fewer RBCs (17.2%) and 14.8% white blood cells.
- Histopathology of embolized thrombi resembled other large vessel occlusion stroke etiologies.
Implications:
- Significant differences in clot composition between in situ and embolized thrombi suggest distinct mechanisms of clot formation and embolization in carotid webs.
- These findings may guide future research into the specific etiology of embolization from carotid webs.
- Further studies are needed to validate these histopathological observations and their clinical relevance.
