Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank

Abstract

Purpose The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. Methods The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. Results The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00–1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00–1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. Conclusion Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.

Outcome Comparison of Endovascular Treatment for Acute Large Vessel Occlusion Due to Large Artery Atherosclerosis and Cardioembolism in the Chinese Population: Data from the ANGEL Registry

“…We observed that patients with LAA were younger (63[55-72] vs 67[59-75], P = 0.003) and had a higher rate of male (84.3% vs 44.4%, P<0.001), lower admission NIHSS (14 [9][10][11][12][13][14][15][16][17][18] vs 20 [14][15][16][17][18][19][20][21][22][23], P<0.001) and longer time from onset to puncture (300[220-440] vs 260[186-335], P<0.001) than those with CE. The prevalence of smoking history (37.9% vs 18.1%, P<0.001), hypertension (55.5% vs 40.3%, P=0.001), and tandem lesion (26.0% vs 0, P<0.001) were more in the LAA group than CE group; while the prevalence of atrial fibrillation was less in LAA group than CE group (10.7% vs 64.4%, P<0.001).…”

Association between Left Atrial Appendage Morphology and Clot Histology in Patients with Embolic Ischemic Stroke: An Exploratory Study

“…Some studies have found diverse fibrin and red blood cell (RBC) proportions in clots between large-artery atherosclerosis and cardioembolic stroke. However, no significant difference has been observed between cardioembolic strokes and strokes of undetermined source [ 4 , 5 ]. Furthermore, existing data indicate that various morphologies of the left atrial appendage (LAA) exhibit diverse flow patterns and varying levels of stroke risk, with the chicken-wing type showing the lowest risk [ 6 , 7 ].…”

Label-free histological analysis of retrieved thrombi in acute ischemic stroke using optical diffraction tomography and deep learning

“…The thrombus composition is also related to the clinical outcomes of recanalization with thrombolysis or endovascular thrombectomy [1]. Studies have identified the pre-interventional migration, vascular origin, and age of thrombi from their histological composition and structure [2,3] , while others have differentiated cardioembolic from non-cardioembolic origin using the proportion of fibrin/platelets or red blood cells (RBCs) in thrombi [4,5].…”