Histopathologic Composition of Cerebral Thrombi of Acute Stroke Patients Is Correlated with Stroke Subtype and Thrombus AttenuationReportar como inadecuado

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We related composition of cerebral thrombi to stroke subtype and attenuation on non-contrast CT NCCT to gain more insight in etiopathogenesis and to validate thrombus attenuation as a new imaging biomarker for acute stroke.


We histopathologically investigated 22 thrombi retrieved after mechanical thrombectomy in acute stroke patients. First, thrombi were classified as fresh, lytic or organized. Second, percentages of red blood cells RBCs, platelets and fibrin and number of red, white respectively RBCs or platelets outnumbering other components with ≥15% or mixed thrombi were compared between large artery atherosclerosis LAA, cardioembolism, dissection and unknown subtype. Third, correlation between attenuation and RBCs, platelets and fibrin was calculated using Pearson-s correlation coefficients r.


Thrombi were fresh in 73% n = 16, lytic in 18% n = 4 and organized in 9% n = 2. The stroke cause was LAA in eight 36%, cardioembolism in six 27%, dissection in three 14%, and unknown in five 23% patients. LAA thrombi showed the highest percentage RBCs median 50 range 35–90, followed by dissection 35 20–40, p = 0.05, cardioembolism 35 5–45, p = 0.013 and unknown subtype 25 2–40, p = 0.006. No differences in platelets p = 0.16 and fibrin p = 0.52 between subtypes were found. LAA thrombi were classified as red or mixed both n = 4, cardioembolisms as mixed n = 5 or white n = 1 and dissection as mixed n = 3. There was a moderate positive correlation between attenuation and RBCs r = 0.401, p = 0.049, and weak negative correlations with platelets r = −0.368, p = 0.09 and fibrin r = −0.073, p = 0.75.


The majority of cerebral thrombi is fresh. There are no differences in age of thrombi between subtypes. LAA thrombi have highest percentages RBCs, cardioembolism and unknown subtype lowest. No relationship exists between subtype and platelets or fibrin percentages. We found a correlation between the RBC-component and thrombus attenuation, which improves validation of thrombus attenuation on NCCT as an imaging biomarker for stroke management.

Autor: Joris M. Niesten , Irene C. van der Schaaf, Lievay van Dam, Aryan Vink, Jan Albert Vos, Wouter J. Schonewille, Peter C. de Bruin,

Fuente: http://plos.srce.hr/


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