Abstract
Mechanical thrombectomy is a novel treatment option for patients with acute ischemic stroke (AIS). Only a few studies have previously suggested strategies to categorize retrieved clots according to their histologic composition. However, these reports did not analyze potential biomarkers that are of importance in stroke-related inflammation. We therefore histopathologically investigated 37 intracerebral thrombi mechanically retrieved from patients with AIS, and focused on the composition of immune cells and platelets. We also conducted correlation analyses of distinctive morphologic patterns (erythrocytic, serpentine, layered, red, white, mixed appearance) with clinical parameters. Most T cells and monocytes were detected in erythrocytic and red clots, in which the distribution of these cells was random. In contrast, von Willebrand factor (vWF)-positive areas co-localized with regions of fibrin and collagen. While clots with huge amounts of vWF seem to be associated with a high National Institute of Health Stroke Scale score at admission, histologic findings could not predict the clinical outcome at discharge. In summary, we provide the first histologic description of mechanically retrieved intracerebral thrombi regarding biomarkers relevant for inflammation in ischemic stroke.
Highlights
After successful clinical trials in patients with occlusion of a major intracranial artery, mechanical thrombectomy (MT) with stent retrievers adds a novel therapeutic option in patients with acute ischemic stroke (AIS) [1,2,3]
As MT is only applicable in approximately 5%–10% of patients with ischemic stroke, intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator is still the treatment of choice for most patients with AIS [4]
(51%)3[711], anMd acco6r0ding to tYhees content ofBthAe red blooNdocells (RBC23s) and fibrin3/collagenla/smriexded(35%), white (B3A8%, b)a,siolarrmaritexreyd; C(-2T7, %int)ra[c1r2a]ni(aTl apbarlteo1f,thFeiginuterrena1lAca)r.otid artery (“carotid-T”); F, female; M, male; middle cerebral artery (MCA), Inmthidedlneecxertebstraelpa,rtwerey;cthorrormelbautsehdisttohleoghyi:set,oepryaththrooclyotigc;icl, ltahyreoremd;bsu, sserspuenbtginreo.ups (Figure 1B,C) with the number of immune cells (CD4+ T cells, CD68+ monocytes) and the fraction of von Willebrand factor (vWF)+ areas
Summary
After successful clinical trials in patients with occlusion of a major intracranial artery, mechanical thrombectomy (MT) with stent retrievers adds a novel therapeutic option in patients with acute ischemic stroke (AIS) [1,2,3]. In IVT [5], but not MT with stent retrievers [6], the response to therapy regarding recanalization and subsequent clinical outcome depends on thrombus length. Recanalization rates and clinical outcomes are dependent on thrombus density in computed tomography (CT) imaging—and dependent on histologic thrombus composition—in both therapeutic strategies, IVT [7,8] as well as MT [9]. We aimed for a detailed characterization of the retrieved cerebral thrombi regarding biomarkers that play major roles in stroke-related inflammation
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