{
  "abstract": "Background Thrombus composition in acute ischemic stroke (AIS) influences responsiveness to intravenous thrombolysis and mechanical thrombectomy. While admission laboratory variables have been associated with clinical outcomes, their relationship to thrombus composition itself remains unclear.Methods We performed a retrospective cohort study of patients with AIS due to large vessel occlusion undergoing mechanical thrombectomy at a single tertiary center. Retrieved thrombi were processed and stained using Martius Scarlet Blue (MSB), allowing differentiation of RBC, fibrin, and platelet components. Whole-slide digital images were analyzed using semi-automated software to quantify the proportional composition of each thrombus. Clots were categorized as red, mixed, or white using predefined thresholds, while continuous component percentages were used for regression analyses. Associations between admission clinical variables, laboratory values, and thrombus composition were assessed using univariate analyses and multivariable linear regression. Receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory ability of significant predictors. Representative thrombus morphology and histology are shown in figure 1.Results A total of 161 patients were included (median age 70 years; 53.4% male). Median thrombus RBC and fibrin/platelet content were 48.5% (IQR 31.4-61.8) and 47.8% (IQR 33.7-63.8), respectively. Thrombi were classified as red in 28.6%, mixed in 39.8%, and white in 31.7% of cases. Admission hemoglobin differed significantly across thrombus phenotypes (p=0.038), with higher levels observed in RBC-rich thrombi. In multivariable regression, admission hemoglobin was independently associated with increased thrombus RBC content (β 2.13 per g/dL; 95% CI 0.17-4.10; p=0.034) and inversely associated with fibrin/platelet content (β -2.12; 95% CI -4.08 to -0.16; p=0.034). Although platelet count differed across groups in univariate analysis (p=0.023), it was not independently associated with thrombus composition after adjustment. No significant independent associations were observed for age, sex, vascular risk factors, thrombolysis, or time to treatment. Stratified analyses demonstrated a graded relationship between hemoglobin levels and thrombus composition, with increasing hemoglobin corresponding to progressively higher RBC proportions. ROC analysis showed modest discriminatory performance of hemoglobin for distinguishing red from white thrombi (AUC 0.61; 95% CI 0.49-0.73).Conclusions Admission hemoglobin is independently associated with thrombus composition in AIS, with higher levels linked to RBC-rich clot architecture. Other routinely measured variables were not predictive, suggesting systemic hematologic status may reflect underlying clot biology.Representative images of thrombi retrieved from stroke patients grossly (A 1, B 1, and C 1), and their corresponding MSB staining (A 2, B 2, and C 3, respectively).Disclosures A. Mohammed: None. O. Mereuta: None. G. El-Hajj: None. J. McDonald: None. D. Dai: None. D. Douri: None. F. Alsereidi: None. A. Rabinstein: None.Abstract E-038 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Neurologic Surgery, Mayo clinic, Rochester, MN"
      ],
      "name": "A Mohammed"
    },
    {
      "affiliations": [
        "Radiology, Mayo clinic, Rochester, MN"
      ],
      "name": "O Mereuta"
    },
    {
      "affiliations": [
        "Mayo Clinic, Rochester, MN"
      ],
      "name": "S Ghozy"
    },
    {
      "affiliations": [
        "Radiology, Mayo clinic, Rochester, MN"
      ],
      "name": "G El-Hajj"
    },
    {
      "affiliations": [
        "Radiology, Mayo clinic, Rochester, MN"
      ],
      "name": "J McDonald"
    },
    {
      "affiliations": [
        "Radiology, Mayo Clinic, Rochester, MN"
      ],
      "name": "D Dai"
    },
    {
      "affiliations": [
        "Neurologic Surgery, Mayo clinic, Rochester, MN"
      ],
      "name": "D Douri"
    },
    {
      "affiliations": [
        "Neurologic Surgery, Mayo clinic, Rochester, MN"
      ],
      "name": "F Alsereidi"
    },
    {
      "affiliations": [
        "Radiology, Mayo Clinic, Rochester, MN"
      ],
      "name": "D Kallmes"
    },
    {
      "affiliations": [
        "Radiology, Mayo Clinic, Rochester, MN"
      ],
      "name": "W Brinjikji"
    },
    {
      "affiliations": [
        "Neurology, Mayo clinic, Rochester, MN"
      ],
      "name": "A Rabinstein"
    },
    {
      "affiliations": [
        "Mayo Clinic, Rochester, MN"
      ],
      "name": "R Kadirvel"
    }
  ],
  "title": "E-038 Admission hemoglobin reflects thrombus composition in large vessel occlusion stroke",
  "uid": "3fe07084-c52e-56bd-97b6-e75a250bff96"
}