Thrombus composition in ischaemic stroke: histological and radiological evaluation, and implications for acute clinical management

Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W et al (2022) World stroke organization (WSO): global stroke fact sheet 2022. Int J Stroke Off J Int Stroke Soc 17(1):18–29

Article  Google Scholar 

King D, Wittenberg R, Patel A, Quayyum Z, Berdunov V, Knapp M (2020) The future incidence, prevalence and costs of stroke in the UK. Age Ageing 49(2):277–282

Article  PubMed  PubMed Central  Google Scholar 

Pu L, Wang L, Zhang R, Zhao T, Jiang Y, Han L (2023) Projected global trends in ischemic stroke incidence, deaths and disability-adjusted life years from 2020 to 2030. Stroke 54(5):1330–1339

Article  PubMed  Google Scholar 

Stroke statistics | Stroke Association [Internet]. [cited 2024 Oct 2]. Available from: https://www.stroke.org.uk/stroke/statistics

Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke 24(1):35–41

Article  PubMed  Google Scholar 

Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372(1):11–20

Article  PubMed  Google Scholar 

Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J et al (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372(11):1019–1030

Article  CAS  PubMed  Google Scholar 

Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372(11):1009–1018

Article  CAS  PubMed  Google Scholar 

Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM et al (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372(24):2285–2295

Article  CAS  PubMed  Google Scholar 

Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A et al (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372(24):2296–2306

Article  CAS  PubMed  Google Scholar 

Liao Y, Guan M, Liang D, Shi Y, Liu J, Zeng X et al (2020) Differences in pathological composition among large artery occlusion cerebral thrombi, valvular heart disease atrial thrombi and carotid endarterectomy plaques. Front Neurol 7(11):811

Article  Google Scholar 

Sporns PB, Hanning U, Schwindt W, Velasco A, Minnerup J, Zoubi T et al (2017) Ischemic stroke: what does the histological composition tell us about the origin of the thrombus? Stroke 48(8):2206–2210

Article  PubMed  Google Scholar 

Jolugbo P, Ariëns RAS (2021) Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischemic stroke. Stroke 52(3):1131–1142

Article  CAS  PubMed  PubMed Central  Google Scholar 

Roessler FC, Kalms N, Jann F, Kemmling A, Ribbat-Idel J, Stellmacher F et al (2021) First approach to distinguish between cardiac and arteriosclerotic emboli of individual stroke patients applying the histological THROMBEX-classification rule. Sci Rep 19(11):8433

Article  Google Scholar 

Akoum N (2016) New perspectives on atrial fibrillation and stroke. Heart Br Card Soc 102(22):1788–1792

CAS  Google Scholar 

Fitzgerald S, Rossi R, Mereuta OM, Jabrah D, Okolo A, Douglas A et al (2021) Per-pass analysis of acute ischemic stroke clots: impact of stroke etiology on extracted clot area and histological composition. J NeuroInterventional Surg 13(12):1111–1116

Article  Google Scholar 

Ahn SH, Hong R, Choo IS, Heo JH, Nam HS, Kang HG et al (2016) Histologic features of acute thrombi retrieved from stroke patients during mechanical reperfusion therapy. Int J Stroke Off J Int Stroke Soc 11(9):1036–1044

Article  Google Scholar 

Maekawa K, Shibata M, Nakajima H, Mizutani A, Kitano Y, Seguchi M et al (2018) Erythrocyte-Rich thrombus is associated with reduced number of maneuvers and procedure time in patients with acute ischemic stroke undergoing mechanical thrombectomy. Cerebrovasc Dis Extra 8(1):39–49

Article  PubMed  PubMed Central  Google Scholar 

Boeckh-Behrens T, Kleine JF, Zimmer C, Neff F, Scheipl F, Pelisek J et al (2016) Thrombus histology suggests cardioembolic cause in cryptogenic stroke. Stroke 47(7):1864–1871

Article  CAS  PubMed  Google Scholar 

Hund HM, Boodt N, Hansen D, Haffmans WA, Lycklama à Nijeholt GJ, Hofmeijer J et al (2023) Association between thrombus composition and stroke etiology in the Mr Clean registry biobank. Neuroradiology 65(5):933–943

Article  PubMed  PubMed Central  Google Scholar 

Huang J, Killingsworth MC, Bhaskar SMM (2022) Is composition of brain clot retrieved by mechanical thrombectomy associated with stroke aetiology and clinical outcomes in acute ischemic stroke?—A systematic review and meta-analysis. Neurol Int 14(4):748–770

Article  CAS  PubMed  PubMed Central  Google Scholar 

Khismatullin RR, Nagaswami C, Shakirova AZ, Vrtková A, Procházka V, Gumulec J et al (2020) Quantitative morphology of cerebral thrombi related to intravital contraction and clinical features of ischemic stroke. Stroke 51(12):3640–3650

Article  CAS  PubMed  Google Scholar 

Evans NR, Bhakta S, Chowdhury MM, Markus H, Warburton E. Management of carotid atherosclerosis in stroke. Pract Neurol [Internet]. 2024 Apr 8 [cited 2024 Jul 31]; Available from: https://pn.bmj.com/content/early/2024/04/08/pn-2023-003918

Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146(12):857–867

Article  PubMed  Google Scholar 

Brinjikji W, Nogueira RG, Kvamme P, Layton KF, Delgado Almandoz JE, Hanel RA et al (2021) Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the stroke thromboembolism registry of imaging and pathology. J Neurointerventional Surg 13(7):594–598

Article  Google Scholar 

Niesten JM, van der Schaaf IC, van Dam L, Vink A, Vos JA, Schonewille WJ et al (2014) Histopathologic composition of cerebral thrombi of acute stroke patients is correlated with stroke subtype and thrombus attenuation. PLoS ONE 9(2):e88882

Article  PubMed  PubMed Central  Google Scholar 

Kim SK, Yoon W, Kim TS, Kim HS, Heo TW, Park MS (2015) Histologic analysis of retrieved clots in acute ischemic stroke: correlation with stroke etiology and gradient-Echo MRI. Am J Neuroradiol 36(9):1756–1762

Article  CAS  PubMed  PubMed Central  Google Scholar 

Sato Y, Ishibashi-Ueda H, Iwakiri T, Ikeda Y, Matsuyama T, Hatakeyama K et al (2012) Thrombus components in cardioembolic and atherothrombotic strokes. Thromb Res 130(2):278–280

Article  CAS  PubMed  Google Scholar 

Shin JW, Jeong HS, Kwon HJ, Song KS, Kim J (2018) High red blood cell composition in clots is associated with successful recanalization during intra-arterial thrombectomy. PLoS ONE 13(5):e0197492

Article  PubMed  PubMed Central  Google Scholar 

Liebeskind DS, Sanossian N, Yong WH, Starkman S, Tsang MP, Moya AL et al (2011) CT and MRI early vessel signs reflect clot composition in acute stroke. Stroke 42(5):1237–1243

Article  PubMed  PubMed Central  Google Scholar 

Marder VJ, Chute DJ, Starkman S, Abolian AM, Kidwell C, Liebeskind D et al (2006) Analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke. Stroke 37(8):2086–2093

Article  PubMed  Google Scholar 

Duffy S, McCarthy R, Farrell M, Thomas S, Brennan P, Power S et al (2019) Per-Pass analysis of thrombus composition in patients with acute ischemic stroke undergoing mechanical thrombectomy. Stroke 50(5):1156–1163

Article  PubMed  Google Scholar 

Fitzgerald S, Dai D, Wang S, Douglas A, Kadirvel R, Layton KF et al (2019) Platelet-Rich emboli in cerebral large vessel occlusion are associated with a large artery atherosclerosis source. Stroke 50(7):1907–1910

Article  PubMed  PubMed Central  Google Scholar 

Kim B, Kim YM, Jin SC, Lee JW, Lee BI, Kim SE et al (2020) Development of a predictive scale for cardioembolic stroke using extracted thrombi and angiographic findings. J Clin Neurosci Off J Neurosurg Soc Australas 73:224–230

Google Scholar 

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