Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

Aliena‐Valero, Alicia; Baixauli-Martín, Júlia; Torregrosa, Germán; Tembl, José Ignacio; Salom, Juan B.

doi:10.5853/jos.2021.02306

Cited by 15 publications

(11 citation statements)

References 134 publications

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“…Across all retrieved thrombus, 10 were retrieved by ADAPT technique, 20 by stent retrieved, and 64 by a combination of aspiration and stent retrieval. For NCCT analysis, the median thrombus attenuation was 50 (9), and the volume was 0.10 (0.21). For histopathological analysis, 12 of the retrieved thrombi were classified as red clots [red blood cell (RBC) dominant], 62 were classified as mixed clots (RBC equal to fibrin), 10 were classified as white clots (fibrin dominant), and the other 10 were classified as organized clots.…”

Section: Resultsmentioning

confidence: 99%

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High Actin Expression in Thrombus of Acute Ischemic Stroke Can Be a Biomarker of Atherothrombotic Origin Stroke

Wang

Jiang

et al. 2022

Front. Neurol.

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BackgroundAs the treatment target, the imaging information and histologic characteristics of the thrombus may differ according to the stroke subtype. This study aimed to provide the correlative study of stroke etiology with the non-contrast CT, and histological composition of retrieved clots in acute ischemic stroke (AIS).Materials and MethodsA total of 94 patients with AIS who underwent the endovascular treatment with successfully retrieved clots from January 2017 to October 2020 were enrolled in the present study. Histological analysis was performed using hematoxylin and eosin (H&E) staining and immunostaining with CD3, CD20, CD105, and actin antibodies. CT obtained at the patients' admission was to measure the attenuation and volume of all thrombus.ResultsA total of 94 subjects were included in this study. Fifty-six patients were classified as cardioembolic (CE), and 38 were classified with large-artery atherosclerosis (LAA). The subjects with LAA tend to exhibit higher actin and CD105 levels, and lower Hounsfield Unit (HU) values than subjects with CE. After adjusting for confounders, the actin was positively correlated with CD105 but not with HU values. Logistics regression shows actin was valuable for the prediction of LAA (OR, 1.148; 95% CI, 1.075–1.227; p < 0.001), even adjusted for age, sex, and intervention type (OR, 1.129; 95% CI, 1.048–1.216; p = 0.001), CT density and CD105 (OR, 1.161; 95% CI, 1.056–1.277; p = 0.002). Actin levels have a strong accuracy in differentiating LAA from CE, especially combined with CT density and CD105, which yielded a sensitivity of 63.2%, a specificity of 89.3%, with the area under the curve (AUC) at 0.821 (95% CI, 0.731–0.912).ConclusionOur findings suggest that actin's level was a major factor differentiating atherothrombotic origin strokes from the cardioembolic stroke.Clinical Trial RegistrationChiCTR2100051173.

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Section: Resultsmentioning

confidence: 99%

“…Therefore, their association with each other is essential for patients with AIS. If there is no such link, it would suggest that more advanced analyses such as microRNA signatures and proteomic analysis should be considered to elucidate the composition of the thrombus (9).…”

Section: Introductionmentioning

confidence: 99%

High Actin Expression in Thrombus of Acute Ischemic Stroke Can Be a Biomarker of Atherothrombotic Origin Stroke

Wang

Jiang

et al. 2022

Front. Neurol.

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“…The TAT in subtypes of ischemic stroke differs depending on the underlying mechanism of embolus formation. Thrombosis in the coronary artery or heart cavity caused by rupture or fissuring of plaques or damage to the heart structure will flow and block the cerebral vessels, especially in atrial fibrillation [ 32 ]. Besides, compared with cerebrovascular, plentiful large clotting factors were activated in the heart blood vessel, more blood cells are recruited and a large amount of fibrinogen is activated, and then thrombi are formed.…”

Section: Discussionmentioning

confidence: 99%

Effect of plasma thrombin-antithrombin complex on ischemic stroke: a systematic review and meta-analysis

Song

Xie

et al. 2023

Syst Rev

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Background and objective Thrombin-antithrombin complex (TAT) is a prethrombotic marker, and its application in ischemic stroke is still uncertain. The purpose of this systematic review and meta-analysis is to evaluate the relationship between plasma TAT and ischemic stroke base on the current evidence. Methods A systematic literature search was conducted for searching the relative studies that investigated the association of TAT and ischemic stroke in PubMed, EMBASE, and Cochrane library databases. Mean difference and 95% confidence interval as the effect sizes were synthesized by random effects model in Review Manager (RevMan) Version 5.4. The heterogeneity was investigated using the chi-square test and the possible sources of heterogeneity were explored by sensitivity analysis and meta-regression. The publication bias was estimated by Egger’s tests. Results A total of 12 eligible studies were included involving 1431 stroke cases and 532 healthy controls, of which six studies were eventually included in the meta-analysis. Plasma TAT in patients with ischemic stroke was significantly higher than that in healthy controls (MD 5.31, 95% CI = 4.12–6.51, P < 0.0001, I2 = 97.8%). There is a difference of TAT level in the same period among cardioembolic, lacunar, and atherothrombotic stroke (all P < 0.0001), in which the cardioembolic stroke with the highest level. Meanwhile, it is significant of TAT levels among various phases of cardioembolic stroke and the acute phase are markedly elevated (MD 7.75, 95CI%, 6.07–9.43, P < 0.001). However, no difference was found in the atherothrombotic (P = 0.13) and lacunar stroke (P = 0.34). Besides, the higher TAT level is closely related to the poor prognosis of patients with ischemic stroke, including higher recurrence, mortality, unfavorable recovery (modified Rankin scale > 2), and poor revascularization. Conclusions This study suggested that plasma TAT levels are different in ischemic stroke subtypes, which are closely associated with the progression and might have an effect on the prognosis. Systematic review registration PROSPERO CRD: 42021248787

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“…Abbreviations: AMI, acute myocardial infarction: CT, computed tomography: DL, dyslipidemia: DM, diabetes mellitus: HTN, hypertension: ICA, internal carotid artery: IV-tPA, intravenous recombinant tissue plasminogen activator: MCA, middle cerebral artery: MRI, magnetic resonance imaging: N/A, not applicable: OTR, onset to reperfusion: PCI, percutaneous coronary intervention: RBC, red blood cell: SR, stent retriever eligible studies (97 cohort studies, 31 case reports, and 6 case series) has showed that the associations of thrombus size, structure, and composition with their etiology were inconsistent. 9) Meanwhile, there are no cohort studies examining the association between cholesterol crystals and embolic source in cerebral embolism. It is only stated on the premise that the thrombus containing them is atheroma in the studies that have assessed thrombectomy-induced wall damage, stiffness and elasticity of thrombus, or reperfusion rates.…”

Section: Discussionmentioning

confidence: 99%

Cholesterol Crystals in the Retrieved Thrombus by Mechanical Thrombectomy for Cerebral Embolism: A Case Report and Literature Review

Sugiyama

Hasegawa

KUDO

et al. 2022

NMC Case Report Journal

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There are only a few case reports in which cholesterol crystals were found in the thrombus retrieved by mechanical thrombectomy for cryptogenic stroke, leading to a definitive diagnosis. We herein report a case of aortogenic embolic stroke diagnosed by the presence of rich cholesterol crystals in the retrieved thrombus and review the previously reported cases. A woman in her 80s was transferred as an emergency due to consciousness disturbance, right conjugate deviation, and severe left hemiparesis. Magnetic resonance imaging showed occlusion of the right middle cerebral artery (MCA) and acute infarction in the territory. The MCA was recanalized by thrombectomy using an aspiration catheter and stent retriever, and the symptoms improved. Although the physiological examination did not detect the embolic source during hospitalization, pathological examination of the thrombus revealed atheroma with numerous cholesterol crystal clefts and intermixing of fibrin. Contrast-enhanced computed tomography performed based on the pathological results showed atheromatous lesions in the aortic arch as the embolic source. As a subsequent treatment, medications of a strong statin and an antiplatelet agent were continued, and the patient had no recurrence. The finding that the retrieved thrombus is a simple atheroma containing cholesterol crystals with poor hemocytes suggests embolism due to plaque rupture. Pathological examination of the thrombus obtained by thrombectomy is one of the useful diagnostic approaches for stroke etiology and the determination of its treatment.

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Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

Cited by 15 publications

References 134 publications

High Actin Expression in Thrombus of Acute Ischemic Stroke Can Be a Biomarker of Atherothrombotic Origin Stroke

High Actin Expression in Thrombus of Acute Ischemic Stroke Can Be a Biomarker of Atherothrombotic Origin Stroke

Effect of plasma thrombin-antithrombin complex on ischemic stroke: a systematic review and meta-analysis

Cholesterol Crystals in the Retrieved Thrombus by Mechanical Thrombectomy for Cerebral Embolism: A Case Report and Literature Review

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