Abstract
Emergent reperfusion therapies have improved acute ischemic stroke prognosis, but many patients are still bound to bad clinical outcome, probably because of our incomplete knowledge of its pathophysiology. Thanks to mechanical thrombectomy, occluding material is available for histological analysis. Several studies investigated the possible relationship between thrombus composition and clinical, procedural, and radiological variables of acute ischemic stroke. The potential value of thrombus analysis as a tool for clinical practice and research is still not defined, as data from the literature are heterogeneous and sometimes conflicting. We propose a review of the existing literature regarding histological analysis of thrombi in acute ischemic stroke. We classified articles on clot composition according to the clinical variable explored in each study. We first distinguished articles about etiology, procedural, and radiological variables, and then we performed a subclassification for each group. This review could help both in the interpretation of thrombus analysis in clinical practice and in its usage for future research.
Highlights
Mechanical thrombectomy (MT) represents a milestone in the field of acute ischemic stroke (AIS) therapy thanks to its demonstrated beneficial effect over a large portion of patients, who were otherwise bound to high rates of poor functional outcome[1].AIS remains a leading cause of disability and the second cause of death worldwide[2]
This study demonstrated that both techniques were able to characterize clot composition and that acoustic radiation force optical coherence elastography (ARF-OCE) could better differentiate red blood cells (RBCs) content compared to shear wave elastography (SWE)[95]
Analysis of thrombi retrieved after MT might give some hints about this complexity, but data from literature are still too heterogeneous
Summary
Mechanical thrombectomy (MT) represents a milestone in the field of acute ischemic stroke (AIS) therapy thanks to its demonstrated beneficial effect over a large portion of patients, who were otherwise bound to high rates of poor functional outcome[1].AIS remains a leading cause of disability and the second cause of death worldwide[2]. About 30% of technically successful MTs are classified as futile recanalization, i.e., complete reperfusion without good clinical outcome[3]. The reasons for clinically unsuccessful therapeutic interventions on AIS are not totally understood, probably because of our imperfect knowledge of AIS pathophysiology. Besides their therapeutic effect, endovascular treatments made it possible to analyze thrombotic material responsible for large vessels occlusion. The existing evidence outlines that cerebral artery occlusion is a multifactorial process which involves the source of the occluding material, the site of occlusion, comorbidities, inflammatory state, and even the recanalization procedure itself[5]
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