Peter B Sporns1, Uta Hanning2, Wolfram Schwindt2, Aglaé Velasco2, Jens Minnerup2, Tarek Zoubi2, Walter Heindel2, Astrid Jeibmann2, Thomas Ulrich Niederstadt2. 1. From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.). peter.sporns@ukmuenster.de. 2. From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.).
Abstract
BACKGROUND AND PURPOSE: The introduction of stent retrievers allows for a complete extraction and histological analysis of human thrombi. Ischemic stroke is a major health issue, and differentiation of underlying causes is highly relevant to prevent recurrent stroke. Therefore, histopathologic analysis of the embolic clots after removal may provide valuable information about underlying pathologies. This study analyzes histological clot composition and aims to identify specific patterns that might help to distinguish causes of ischemic stroke. METHODS: Patients with occlusion of the carotid-T or middle cerebral artery who underwent thrombectomy at our university medical center between December 2013 and February 2016 were included. Samples were histologically analyzed (hematoxylin and eosin, Elastica van Gieson, and Prussian blue), additionally immunohistochemistry for CD3, CD20, and CD68/KiM1P was performed. These data, along with additional clinical and interventional parameters, were compared for different stroke subtypes, as defined by the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. RESULTS: One hundred eighty-seven patients were included, of these, in 77 patients, cardioembolic; in 46 patients, noncardioembolic; and in 64 patients, cryptogenic pathogenesis was determined. Cardioembolic thrombi had higher proportions of fibrin/platelets (P=0.027), less erythrocytes (P=0.005), and more leucocytes (P=0.026) than noncardioembolic thrombi. We observed a strong overlap of cryptogenic strokes and cardioembolic strokes concerning thrombus histology. The immunohistochemical parameters CD3, CD20, and CD68/KiM1P showed no statistically noticeable differences between stroke subtypes. CONCLUSIONS: Histological thrombus features vary significantly according to the underlying cause and may help to differentiate between cardioembolic and noncardioembolic stroke. In addition, our study supports the hypothesis that most cryptogenic strokes have a cardioembolic cause.
BACKGROUND AND PURPOSE: The introduction of stent retrievers allows for a complete extraction and histological analysis of human thrombi. Ischemic stroke is a major health issue, and differentiation of underlying causes is highly relevant to prevent recurrent stroke. Therefore, histopathologic analysis of the embolic clots after removal may provide valuable information about underlying pathologies. This study analyzes histological clot composition and aims to identify specific patterns that might help to distinguish causes of ischemic stroke. METHODS:Patients with occlusion of the carotid-T or middle cerebral artery who underwent thrombectomy at our university medical center between December 2013 and February 2016 were included. Samples were histologically analyzed (hematoxylin and eosin, Elastica van Gieson, and Prussian blue), additionally immunohistochemistry for CD3, CD20, and CD68/KiM1P was performed. These data, along with additional clinical and interventional parameters, were compared for different stroke subtypes, as defined by the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. RESULTS: One hundred eighty-seven patients were included, of these, in 77 patients, cardioembolic; in 46 patients, noncardioembolic; and in 64 patients, cryptogenic pathogenesis was determined. Cardioembolic thrombi had higher proportions of fibrin/platelets (P=0.027), less erythrocytes (P=0.005), and more leucocytes (P=0.026) than noncardioembolic thrombi. We observed a strong overlap of cryptogenic strokes and cardioembolic strokes concerning thrombus histology. The immunohistochemical parameters CD3, CD20, and CD68/KiM1P showed no statistically noticeable differences between stroke subtypes. CONCLUSIONS: Histological thrombus features vary significantly according to the underlying cause and may help to differentiate between cardioembolic and noncardioembolic stroke. In addition, our study supports the hypothesis that most cryptogenic strokes have a cardioembolic cause.
Authors: Seán Fitzgerald; Daying Dai; Shunli Wang; Andrew Douglas; Ramanathan Kadirvel; Kennith F Layton; Ike C Thacker; Matthew J Gounis; Ju-Yu Chueh; Ajit S Puri; Mohammed Almekhlafi; Andrew M Demchuk; Ricardo A Hanel; Eric Sauvageau; Amin Aghaebrahim; Albert J Yoo; Peter Kvamme; Vitor M Pereira; Yasha Kayan; Josser E Delgado Almandoz; Raul G Nogueira; Alejandro A Rabinstein; David F Kallmes; Karen M Doyle; Waleed Brinjikji Journal: Stroke Date: 2019-05-29 Impact factor: 7.914
Authors: Waleed Brinjikji; Sharon Duffy; Anthony Burrows; Werner Hacke; David Liebeskind; Charles B L M Majoie; Diederik W J Dippel; Adnan H Siddiqui; Pooja Khatri; Blaise Baxter; Raul Nogeuira; Matt Gounis; Tudor Jovin; David F Kallmes Journal: J Neurointerv Surg Date: 2016-05-10 Impact factor: 5.836
Authors: J Goebel; B-J Gaida; I Wanke; C Kleinschnitz; M Koehrmann; M Forsting; C Moenninghoff; A Radbruch; A Junker Journal: AJNR Am J Neuroradiol Date: 2020-03-19 Impact factor: 3.825