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Research ArticleNeurointervention

Is Histologic Thrombus Composition in Acute Stroke Linked to Stroke Etiology or to Interventional Parameters?

J. Goebel, B.-J. Gaida, I. Wanke, C. Kleinschnitz, M. Koehrmann, M. Forsting, C. Moenninghoff, A. Radbruch and A. Junker
American Journal of Neuroradiology March 2020, DOI: https://doi.org/10.3174/ajnr.A6467

Article Figures & Data

Figures

  • FIG 1.
    FIG 1.

    Percentages of the different clot components. Each investigated thrombus is shown in its quantitative composition of fibrin, platelets, red blood cells, and white blood cells (including macrophages, leukocytes, and granulocytes).

  • FIG 2.
    FIG 2.

    Differences between the different stroke subtypes in the proportions of platelets and macrophages (subunits A and B) and differences between the individual thrombi in the proportions of platelets and the number of fragments that were ultimately retrieved by contact aspiration alone, stent retrieval alone, or a combination of the 2 techniques (subunits C and D).

Tables

  • Table 1:

    Antibodies and staining procedures

    AntigenSourcePretreatmentDilution
    CD68 (Ki-M1P)Dr Klapper, Institute for Pathology, Kiel, GermanyNone1:10,000
    CD45 (LCA) (mouse monoclonal, 2B11 + PD7/26)Dako, Hamburg, GermanyCitrate1:1000

    • Note:—LCA indicates leukocyte common antigen.

  • Table 2:

    Baseline characteristics and preinterventional imaging results of the studied patientsa

    Characteristics and Results
    Total No. of patients85
    Sex (No.)37 Men/48 women
    Age (yr)72.0 ± 12.9
    Vascular risk factors (No.) (multiple choices possible)
        Atrial fibrillation50 (58.8%)
        Hypertension70 (82.4%)
        Diabetes24 (28.2%)
        High blood cholesterol levels53 (62.4%)
        Smoking19 (22.4%)
        Excessive alcohol intake1 (1.2%)
        Obesity7 (8.2%)
        Heart disease other than atrial fibrillation44 (51.8%)
    Patients with previous ischemic stroke (No.)18 (21.2%)
    Subtypes of ischemic stroke (No.)
        Major-risk source cardiogenic embolism51 (60.0%)
        Large-artery atherosclerotic stenosis16 (18.8%)
        ESUS17 (20.0%)
        Unusual (eg, dissection)1 (1.2%)
    Initial NIHSS score13 (0–28)
    Initial stroke imaging (No.)
        CT83
        DSA2
    Occlusion site (No.)
        Internal carotid artery (intracranial)28 (32.9%)
        MCA, M1 segment36 (42.4%)
        MCA, M2 segment10 (11.8%)
        Basilar artery9 (10.6%)
        Anterior cerebral artery1 (1.2%)
        Posterior cerebral artery1 (1.2%)
    Dense artery sign (n = 71 patients)b43 (60.6%)
    Mean thrombus attenuation (HU) (67 patients)b58 (41–149)
    Initial ASPECTS (in MCA ischemia; n = 64 patients)b10 (3–10)
    Patients given IV tPA (No.)52 (61.2%)
    OTT (n = 56 patients) (min)b172 (96–782)

    • Note:—OTT indicates time interval between symptom onset and start of thrombectomy.

    • ↵a Data are given as number (percent of total), mean ± SD, or median (range).

    • ↵b Data were not available from all 85 patients (On-line Table 1).

  • Table 3:

    Interventional parameters including revascularization rates and data on histopathologic thrombus compositiona

    Parameters
    Duration of thrombectomy (interval between first and last obtained DSA; n = 83 patients) (min)b46 (4–260)
    Achieved tissue reperfusion (No.)
        mTICI 05 (5.9%)
        mTICI 11 (1.2%)
        mTICI 2a2 (2.4%)
        mTICI 2b34 (40.0%)
        mTICI 343 (50.6%)
    Ultimately successful recanalization technique (No.)
        Aspiration (number of passes, median and range) 2 (1–8)47 (55.3%)
        Stent retrieval (number of passes, median and range) 2 (1–5)23 (27.1%)
        Combined aspiration and stent retrieval (number of passes, median and range) 3 (2–8)15 (17.6%)
    Occurrence of endovascular complications (No.)19 (22.4%)
    Occurrence of symptomatic hemorrhage (No.)2 (2.4%)
    ASPECTS 24 hr postthrombectomy (n = 73 patients)b8 (0–10)
    NIHSS score at 2–14 days postthrombectomy (n = 66 patients)b3 (0–21)
    Thrombus components (% from thrombus profile)
        Fibrin40.9 (2.8–68.2)
        Platelets16.1 (1.9–81.1)
        RBC41.7 (1.2–89.9)
        WBC2.6 (0.4–8.5)
            Macrophages0.7 (0.0–5.2)
            Lymphocytes0.3 (0.0–1.7)
            Granulocytes1.5 (0.0–7.1)
    No. of thrombus fragments8 (2–47)

    • Note:— DSA indicates digital subtraction angriography.

    • ↵a Data are given as number and percentage or median and range.

    • ↵b Data were not available in all 85 patients (On-line Table 1).

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Is Histologic Thrombus Composition in Acute Stroke Linked to Stroke Etiology or to Interventional Parameters?
J. Goebel, B.-J. Gaida, I. Wanke, C. Kleinschnitz, M. Koehrmann, M. Forsting, C. Moenninghoff, A. Radbruch, A. Junker
American Journal of Neuroradiology Mar 2020, DOI: 10.3174/ajnr.A6467
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