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Histopathologic composition of cerebral thrombi of acute stroke patients is correlated with stroke subtype and thrombus attenuation.

Niesten JM, van der Schaaf IC, van Dam L, Vink A, Vos JA, Schonewille WJ, de Bruin PC, Mali WP, Velthuis BK - PLoS ONE (2014)

Bottom Line: No differences in platelets (p = 0.16) and fibrin (p = 0.52) between subtypes were found.The majority of cerebral thrombi is fresh.No relationship exists between subtype and platelets or fibrin percentages.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Introduction: 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.

Methods: 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).

Results: 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).

Conclusions: 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.

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Boxplots of percentage red blood cells, platelets and fibrin of thrombi by subtype of stroke.LAA: large artery atherosclerosis, CE: cardioembolism, DIS: dissection, UNK: unknown, RBC: Red blood cell.
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pone-0088882-g002: Boxplots of percentage red blood cells, platelets and fibrin of thrombi by subtype of stroke.LAA: large artery atherosclerosis, CE: cardioembolism, DIS: dissection, UNK: unknown, RBC: Red blood cell.

Mentions: The median percentages of RBCs differed significantly between the different stroke subtypes as a group (p = 0.010) while there were no significant differences in the median percentages of platelets (p = 0.16) and fibrin (p = 0.52) between the different subtypes (table 2 and figure 2). Comparing the individual stroke subtypes; thrombi originating from LAA showed the highest percentage of RBCs (median 50% (35–90%)), which was not significantly different from the dissection subtype (median 35% (20–40%), p = 0.05) but was significantly higher than thrombi from cardioembolisms (median 35% (5–45%), p = 0.013) and unknown subtype (median 25% (2–40%), p = 0.006). The median percentages of RBCs in thrombi from dissection and cardioembolisms (p = 0.82), dissection and unknown subtype (p = 0.33) and cardioembolism and unknown (p = 0.39) were comparable (Figure 2). White blood cells were present in most thrombi but in very small amounts only, in one thrombus a small volume of atheromatous material was seen and calcification was not visible in any thrombus.


Histopathologic composition of cerebral thrombi of acute stroke patients is correlated with stroke subtype and thrombus attenuation.

Niesten JM, van der Schaaf IC, van Dam L, Vink A, Vos JA, Schonewille WJ, de Bruin PC, Mali WP, Velthuis BK - PLoS ONE (2014)

Boxplots of percentage red blood cells, platelets and fibrin of thrombi by subtype of stroke.LAA: large artery atherosclerosis, CE: cardioembolism, DIS: dissection, UNK: unknown, RBC: Red blood cell.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921255&req=5

pone-0088882-g002: Boxplots of percentage red blood cells, platelets and fibrin of thrombi by subtype of stroke.LAA: large artery atherosclerosis, CE: cardioembolism, DIS: dissection, UNK: unknown, RBC: Red blood cell.
Mentions: The median percentages of RBCs differed significantly between the different stroke subtypes as a group (p = 0.010) while there were no significant differences in the median percentages of platelets (p = 0.16) and fibrin (p = 0.52) between the different subtypes (table 2 and figure 2). Comparing the individual stroke subtypes; thrombi originating from LAA showed the highest percentage of RBCs (median 50% (35–90%)), which was not significantly different from the dissection subtype (median 35% (20–40%), p = 0.05) but was significantly higher than thrombi from cardioembolisms (median 35% (5–45%), p = 0.013) and unknown subtype (median 25% (2–40%), p = 0.006). The median percentages of RBCs in thrombi from dissection and cardioembolisms (p = 0.82), dissection and unknown subtype (p = 0.33) and cardioembolism and unknown (p = 0.39) were comparable (Figure 2). White blood cells were present in most thrombi but in very small amounts only, in one thrombus a small volume of atheromatous material was seen and calcification was not visible in any thrombus.

Bottom Line: No differences in platelets (p = 0.16) and fibrin (p = 0.52) between subtypes were found.The majority of cerebral thrombi is fresh.No relationship exists between subtype and platelets or fibrin percentages.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Introduction: 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.

Methods: 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).

Results: 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).

Conclusions: 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.

Show MeSH
Related in: MedlinePlus