Abstract 3333: Serum Lipids and Inflammatory Markers as Predictors of Thrombus Composition in Acute Ischemic Stroke

Abstract

Introduction: Histopathology has shown that thrombi retrieved acutely from cerebral arteries in acute ischemic stroke patients typically have intermixed fibrin-platelet-dominant and red blood cell (RBC)-dominant regions. Knowledge of the proportions of fibrin-platelet and RBC components in an individual patient could help with pharmacologic and/or device intervention selection. Whether serum markers of inflammation and coagulation status reflect clot composition has not previously been investigated. Methods: We analyzed consecutive patients undergoing mechanical thrombectomy for acute middle cerebral artery ischemic stroke with retrieved thrombi available for histopathologic analysis. Percent of retrieved thrombus that was RBC-dominant, WBC-dominant, and platelet/thrombin-dominant was calculated and compared with routine serum indices of inflammatory and coagulation status obtained on admission. Results: Among the 50 patients meeting entry critera, mean age was 66 (SD 21), 48% were female, and median pretreatment NIHSS was 19 (IQR 15-22). Two serum indices demonstrated correlations with cerebral thrombus histopathology: serum WBC count inversely correlated with thrombus fibrin percentage (R -.317, p=0.024) and partial thromboplastin time positively correlated with thrombus WBC percentage (R 0.336, p=0.032). No relations were found for other serum tests, including hemoglobin, neutrophil count, lymphocyte count, prothrombin time, erythrocyte sedimentation rate, high sensitivity C-reactive protein, homocysteine, fibrinogen, factor VIII, total cholesterol, LDL, and HDL. Conclusions: Serum measures of inflammation and coagulation may provide clues to target thrombus composition in acute ischemic stroke. Systemic inflammation, including during infections, may lead to upregulation of clotting factors and less fibrin-platelet and more RBC and WBC-laden clots.