Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank

on behalf of the MR CLEAN Registry Investigators, Hajo M. Hund, Nikki Boodt, Daniel Hansen, Willem A. Haffmans, Geert J. Lycklama à Nijeholt, Jeannette Hofmeijer, Diederik W.J. Dippel, Aad van der Lugt, Adriaan C.G.M. van Es, Heleen M.M. van Beusekom*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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.

Original languageEnglish
Pages (from-to)933–943
Number of pages11
JournalNeuroradiology
Early online date25-Jan-2023
DOIs
Publication statusPublished - 2023

Keywords

  • Endovascular treatment
  • Ischemic stroke
  • Mechanical thrombectomy
  • Microscopy
  • Stent-retriever
  • Thrombus

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