Abstract
Background and Purpose: Acute ischemic stroke (AIS) with large artery occlusion (LAO) may lead to severe disability or death if not promptly treated. To determine the source of cerebral artery occlusion thrombosis, we studied the pathological components of cerebral artery thrombosis with different etiological classifications to guide clinical formulation of preventive treatment.Materials and Methods: Eighty-eight thrombi from AIS patients with LAO, 12 atrial thrombi from patients with valvular heart disease (VHD), and 11 plaques obtained by carotid endarterectomy (CEA) from patients with carotid artery stenosis were included in this retrospective study. The hematoxylin and eosin–stained specimens were quantitatively analyzed for erythrocytes, white blood cells (WBCs) and fibrin; platelets were shown by immunohistochemistry for CD31.Results: The thrombi of VHD showed the highest percentage of fibrin, followed by those of cardioembolism (CE) and stroke of undetermined etiology (SUE), and these values were higher than those of the other groups. Plaques obtained by CEA showed the highest erythrocyte number, followed by the large artery atherosclerosis (LAA) thrombi, and showed significantly noticeable differences between other stroke subtypes. The proportions of fibrin and erythrocytes in the thrombi of CE and SUE were most similar to those in the thrombi of VHD, and the LAA thrombi were the closest to those obtained by CEA. CE thrombi and CEA plaques had a higher percentage of WBCs than thrombi of other stroke thrombus subtypes and VHD.Conclusions: CE and most cryptogenic thrombi may originate from the heart, and the formation of carotid atherosclerotic plaques may be related to atherosclerotic cerebral embolism. Inflammation may be involved in their formation.
Highlights
Acute cerebral large artery occlusion (LAO) may lead to severe disability or even death if the patient does not have access to prompt treatment
The inclusion criteria included patients over 18 years old; all patients who had been treated by intra-arterial mechanical thrombectomy with thrombus were retrieved for histopathological analysis, and LAO patients who did not have visible thrombi for analysis were excluded from this study
There were 88 patients from whom thrombi were retrieved during mechanical thrombectomy; 175 with no thrombus were excluded from the study
Summary
Acute cerebral large artery occlusion (LAO) may lead to severe disability or even death if the patient does not have access to prompt treatment. It is important to identify the etiology of LAO in clinical treatment [1]. The TOAST classification is currently simple and easy to use and advances imaging and diagnostic methods, identifying a clear stroke etiology remains challenging for a certain percentage of stroke patients, especially for patients with atrial fibrillation and intracranial large vascular stenosis or paroxysmal atrial fibrillation, and the etiological mechanisms are difficult to obtain from clinical data [2,3,4]. Acute ischemic stroke (AIS) with large artery occlusion (LAO) may lead to severe disability or death if not promptly treated. To determine the source of cerebral artery occlusion thrombosis, we studied the pathological components of cerebral artery thrombosis with different etiological classifications to guide clinical formulation of preventive treatment
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