TY - JOUR
T1 - Association between Thrombus Composition and Etiology in Patients with Acute Ischemic Stroke Treated by Thrombectomy
AU - Staessens, Senna
AU - Vandelanotte, Sarah
AU - François, Olivier
AU - Boulleaux, Eric
AU - Bretzner, Martin
AU - Casolla, Barbara
AU - Corseaux, Delphine
AU - Puy, Laurent
AU - Denorme, Frederik
AU - De Wilde, Maaike
AU - Desender, Linda
AU - Laridan, Elodie
AU - Vandenbulcke, Aline
AU - de Boer, Jasper
AU - Vens, Celine
AU - De Sloovere, Anne Sophie
AU - Dewaele, Tom
AU - Vanacker, Peter
AU - Susen, Sophie
AU - Tersteeg, Claudia
AU - Vanhoorelbeke, Karen
AU - Cordonnier, Charlotte
AU - Andersson, Tommy
AU - De Meyer, Simon F.
N1 - Publisher Copyright:
© 2025 American Heart Association, Inc.
PY - 2025/4/1
Y1 - 2025/4/1
N2 - BACKGROUND: In ischemic stroke due to large vessel occlusion, cerebral blood flow is impaired by thromboemboli, which can originate from various sources in the body. A better understanding of thromboembolus composition can improve our understanding of the underlying pathophysiology and potentially guide improvement of prevention strategies. The aim of this study therefore was to perform a large-sample multi-parameter quantitative histological analysis of retrieved thromboemboli from stroke patients. METHODS: Thromboemboli (n=501) were collected from thrombectomy-treated ischemic stroke patients at AZ Groeninge Hospital (Kortrijk, Belgium) and CHU Lille (Lille, France). Stroke etiology was determined by the treating stroke specialist using the TOAST classification system (Trial of ORG 10172 in Acute Stroke Treatment). Extensive histological analysis, blinded to stroke etiology, was performed for key thrombus constituents including red blood cells (RBCs), platelets, fibrin, von Willebrand Factor, leukocytes, citrullinated histone H3 (as a marker for neutrophil extracellular traps), and extracellular (ex)DNA. Quantitative histology results were linked to etiology. RESULTS: Compared with large-artery atherosclerotic thromboemboli, cardioembolic thromboemboli contained significantly fewer RBCs and significantly more platelets, fibrin, leukocytes, and exDNA. Interestingly, cryptogenic thromboemboli contained relatively low amounts of RBCs and high amounts of platelets, similar to cardioembolic thromboemboli. A multivariable logistic regression model indicated that it is difficult to predict stroke etiology based on the individual thrombus composition. CONCLUSIONS: Based on a large sample cohort of stroke thromboemboli, we found that cardiac thromboemboli contained fewer RBCs and more platelets than atherosclerotic thromboemboli and that cryptogenic thromboemboli have a similar composition to cardiac thromboemboli in terms of RBCs and platelets.
AB - BACKGROUND: In ischemic stroke due to large vessel occlusion, cerebral blood flow is impaired by thromboemboli, which can originate from various sources in the body. A better understanding of thromboembolus composition can improve our understanding of the underlying pathophysiology and potentially guide improvement of prevention strategies. The aim of this study therefore was to perform a large-sample multi-parameter quantitative histological analysis of retrieved thromboemboli from stroke patients. METHODS: Thromboemboli (n=501) were collected from thrombectomy-treated ischemic stroke patients at AZ Groeninge Hospital (Kortrijk, Belgium) and CHU Lille (Lille, France). Stroke etiology was determined by the treating stroke specialist using the TOAST classification system (Trial of ORG 10172 in Acute Stroke Treatment). Extensive histological analysis, blinded to stroke etiology, was performed for key thrombus constituents including red blood cells (RBCs), platelets, fibrin, von Willebrand Factor, leukocytes, citrullinated histone H3 (as a marker for neutrophil extracellular traps), and extracellular (ex)DNA. Quantitative histology results were linked to etiology. RESULTS: Compared with large-artery atherosclerotic thromboemboli, cardioembolic thromboemboli contained significantly fewer RBCs and significantly more platelets, fibrin, leukocytes, and exDNA. Interestingly, cryptogenic thromboemboli contained relatively low amounts of RBCs and high amounts of platelets, similar to cardioembolic thromboemboli. A multivariable logistic regression model indicated that it is difficult to predict stroke etiology based on the individual thrombus composition. CONCLUSIONS: Based on a large sample cohort of stroke thromboemboli, we found that cardiac thromboemboli contained fewer RBCs and more platelets than atherosclerotic thromboemboli and that cryptogenic thromboemboli have a similar composition to cardiac thromboemboli in terms of RBCs and platelets.
KW - cerebrovascular circulation
KW - fibrin
KW - ischemic stroke
KW - thrombosis
KW - von Willebrand Factor
UR - https://www.scopus.com/pages/publications/105000461585
U2 - 10.1161/STROKEAHA.124.047092
DO - 10.1161/STROKEAHA.124.047092
M3 - Article
C2 - 40127147
AN - SCOPUS:105000461585
SN - 0039-2499
VL - 56
SP - 1026
EP - 1035
JO - Stroke
JF - Stroke
IS - 4
ER -