TY - JOUR
T1 - Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank
AU - on behalf of the MR CLEAN Registry Investigators
AU - Hund, Hajo M.
AU - Boodt, Nikki
AU - Hansen, Daniel
AU - Haffmans, Willem A.
AU - Lycklama à Nijeholt, Geert J.
AU - Hofmeijer, Jeannette
AU - Dippel, Diederik W.J.
AU - van der Lugt, Aad
AU - van Es, Adriaan C.G.M.
AU - van Beusekom, Heleen M.M.
AU - Majoie, Charles B.L.M.
AU - Roos, Yvo B.W.E.M.
AU - van Oostenbrugge, Robert J.
AU - van Zwam, Wim H.
AU - Boiten, Jelis
AU - Vos, Jan Albert
AU - Jansen, Ivo G.H.
AU - Mulder, Maxim J.H.L.
AU - Goldhoorn, Robert Jan B.
AU - Compagne, Kars C.J.
AU - Kappelhof, Manon
AU - Brouwer, Josje
AU - den Hartog, Sanne J.
AU - Hinsenveld, Wouter H.
AU - Roozenbeek, Bob
AU - Emmer, Bart J.
AU - Coutinho, Jonathan M.
AU - Schonewille, Wouter J.
AU - Wermer, Marieke J.H.
AU - van Walderveen, Marianne A.A.
AU - Staals, Julie
AU - Martens, Jasper M.
AU - de Bruijn, Sebastiaan F.
AU - van Dijk, Lukas C.
AU - van der Worp, H. Bart
AU - Lo, Rob H.
AU - van Dijk, Ewoud J.
AU - Boogaarts, Hieronymus D.
AU - de Vries, J.
AU - de Kort, Paul L.M.
AU - van den Berg, Jan S.P.
AU - Uyttenboogaart, Maarten
AU - Bokkers, Reinoud P.H.
AU - den Hertog, Heleen M.
AU - Appelman, Auke P.A.
AU - van der Hoorn, Anouk
AU - Messchendorp, Gert
AU - Boers, Anna M.M.
AU - Groot, P. F.C.
AU - Collette, Sabine L.
N1 - Funding Information:
This study was funded and carried out by the Erasmus University Medical Center, the Academic Medical Center Amsterdam, and the Maastricht University Medical Center. The study was additionally funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 777072 (IN-SIlico trials for treatment of acute Ischemic STroke, INSIST), which played no role in the trial design and patient enrolment or in data the collection, analysis, or writing of the manuscript.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023
Y1 - 2023
N2 - Purpose: The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. Methods: The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. Results: The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00–1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00–1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. Conclusion: Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.
AB - Purpose: The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. Methods: The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. Results: The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00–1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00–1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. Conclusion: Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.
KW - Endovascular treatment
KW - Ischemic stroke
KW - Mechanical thrombectomy
KW - Microscopy
KW - Stent-retriever
KW - Thrombus
U2 - 10.1007/s00234-023-03115-y
DO - 10.1007/s00234-023-03115-y
M3 - Article
C2 - 36695859
AN - SCOPUS:85146977693
SN - 0028-3940
SP - 933
EP - 943
JO - Neuroradiology
JF - Neuroradiology
ER -