Chendong Wang1, Yu Hang1, Yuezhou Cao1, Linbo Zhao1, Jincheng Jiao2, Mingfang Li2, Xiaoquan Xu3, Lei Jiang4, Sheng Liu1, Haibin Shi5, Zhenyu Jia6. 1. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China. 2. Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China. 3. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China. 4. Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China. 5. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China. Electronic address: shihb@njmu.edu.cn. 6. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China. Electronic address: jiazhenyu2021@163.com.
Abstract
PURPOSE: Anticoagulation (AC) is the main preventive strategy for ischemic stroke in atrial fibrillation (AF) patients. We aim to investigate the association of prior AC with thrombus composition and clinical outcome in AF patients with acute ischemic stroke (AIS). MATERIALS AND METHODS: From January 2019 to December 2020, consecutive AIS patients with AF treated with mechanical thrombectomy (MT) in our center were included in this analysis. Retrieved thrombi were stained with hematoxylin and eosin (H&E) and Martius Scarlet blue (MSB). The relative fractions of red blood cell (RBC), white blood cell (WBC), fibrin, and platelet were quantitatively analyzed. Procedural and clinical outcomes were compared between patients with and without prior AC. RESULTS: A total of 133 patients were enrolled in this study, with 39 in AC group and 94 in non-AC (NAC) group. Thrombi in AC group contained more fibrins (36% vs 20%, p<0.001), more platelets (36% vs 24%, p<0.001) and fewer RBCs (25% vs 54%, p<0.001). No difference was detected in terms of successful recanalization evaluated with modified Thrombolysis in Cerebral Infarction scale (mTICI 2b-3, 97% vs 86%, p=0.065), functional independence at 90 days with modified Rankin Score (mRS 0-2, 44% vs 33%, p=0.246). CONCLUSION: Thrombi retrieved from AF patients with prior AC contained more fibrins, more platelets and fewer RBCs compared with those of NAC patients. A trend of higher successful reperfusion rate was observed in AC patients but failed to reach statistical significance.
PURPOSE: Anticoagulation (AC) is the main preventive strategy for ischemic stroke in atrial fibrillation (AF) patients. We aim to investigate the association of prior AC with thrombus composition and clinical outcome in AF patients with acute ischemic stroke (AIS). MATERIALS AND METHODS: From January 2019 to December 2020, consecutive AIS patients with AF treated with mechanical thrombectomy (MT) in our center were included in this analysis. Retrieved thrombi were stained with hematoxylin and eosin (H&E) and Martius Scarlet blue (MSB). The relative fractions of red blood cell (RBC), white blood cell (WBC), fibrin, and platelet were quantitatively analyzed. Procedural and clinical outcomes were compared between patients with and without prior AC. RESULTS: A total of 133 patients were enrolled in this study, with 39 in AC group and 94 in non-AC (NAC) group. Thrombi in AC group contained more fibrins (36% vs 20%, p<0.001), more platelets (36% vs 24%, p<0.001) and fewer RBCs (25% vs 54%, p<0.001). No difference was detected in terms of successful recanalization evaluated with modified Thrombolysis in Cerebral Infarction scale (mTICI 2b-3, 97% vs 86%, p=0.065), functional independence at 90 days with modified Rankin Score (mRS 0-2, 44% vs 33%, p=0.246). CONCLUSION: Thrombi retrieved from AF patients with prior AC contained more fibrins, more platelets and fewer RBCs compared with those of NAC patients. A trend of higher successful reperfusion rate was observed in AC patients but failed to reach statistical significance.