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Clinical Neuroradiology
Published in: Clinical Neuroradiology 2/2016

01-06-2016 | Original Article

The Impact of Histological Clot Composition in Embolic Stroke

Authors: T. Boeckh-Behrens, MD, M. Schubert, MD, A. Förschler, MD, S. Prothmann, MD, K. Kreiser, MD, C. Zimmer, MD, J. Riegger, MD, J. Bauer, MD, F. Neff, MD, V. Kehl, PhD, J. Pelisek, PhD, L. Schirmer, MD, M. Mehr, H. Poppert, MD

Published in: Clinical Neuroradiology | Issue 2/2016

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Abstract

Purpose

Thrombus composition has been suggested to have a decisive impact on the outcome of patients treated by mechanical thrombectomy because of embolic stroke. The recent development of stent retrievers allows collection and, hence, histopathological analysis of fresh thrombus material. Against this background, the aim of this prospective study was to assess the impact of thrombus composition on mechanical recanalization, clinical outcome and stroke etiology.

Methods

Thirty-four patients suffering from acute ischemic stroke due to occlusion of the distal internal carotid artery/carotid-T, anterior cerebral artery, or middle cerebral arteries were mechanically recanalized, and thrombus material was obtained. Histological thrombus composition was compared with imaging, clinical, and neurointerventional data.

Results

The main findings were that a higher percentage of white blood cells (WBCs) in the thrombus was associated with (i) cardioembolic etiology, (ii) extended mechanical recanalization time, and (iii) less favorable recanalization (Thrombolysis in Cerebral Infarction score) and clinical outcome (National Institute of Health Stroke Scale).

Conclusion

Our results suggest that thrombi with a high WBC fraction are related to more organized thrombi of cardioembolic origin associated with less favorable recanalization and clinical outcome in acute ischemic anterior circulation stroke. WBC-mediated immunological and coagulatory processes may play a key role in thrombus formation and pathogenesis of stroke warranting further investigation.
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Metadata
Title
The Impact of Histological Clot Composition in Embolic Stroke
Authors
T. Boeckh-Behrens, MD
M. Schubert, MD
A. Förschler, MD
S. Prothmann, MD
K. Kreiser, MD
C. Zimmer, MD
J. Riegger, MD
J. Bauer, MD
F. Neff, MD
V. Kehl, PhD
J. Pelisek, PhD
L. Schirmer, MD
M. Mehr
H. Poppert, MD
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 2/2016
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-014-0347-x

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