Histological composition behind CT-based thrombus density and perviousness in acute ischemic stroke

Ye, Gengfan; Cao, Ruoyao; Qi, Peng; Shen, Huiyong; Chen, Kunpeng; Tan, Tianhua; Chen, Juan; Wang, Daming

doi:10.1016/j.clineuro.2021.106804

Cited by 16 publications

(31 citation statements)

References 34 publications

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“…Hematoxylin and eosin (H&E) staining was the most commonly performed histological analysis, used by 19 studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Martius Scarlet Blue (MSB) [ 16 , 22 , 23 , 24 , 40 ] and Elastica van Gieson (EVG) [ 18 , 28 , 30 , 32 , 33 , 35 ] staining were both selected in 5 studies, Prussian Blue in 3 [ 18 , 28 , 33 , 35 ], Masson’s trichrome in 2 [ 36 , 37 ], and Ladewig’s trichrome [ 39 ], Von Kossa [ 39 ], naphthol AS-D [ 39 ], chloroacetate [ 39 ], and Mallory’s phosphotungstic acid-hematoxylin [ 18 ] were included once each. One study used scanning electron microscope [ 32 ], and eight studies employed immunohistochemistry in their analyses [ 13 , 15 , 16 , 18 , 22 ,…”

Section: Resultsmentioning

confidence: 99%

“…A total of 10 studies reported on the association between clot composition and pre-interventional imaging signs [ 16 , 25 , 26 , 33 , 35 , 40 , 46 , 47 , 48 , 49 ]. A positive HMCAS was associated with greater RBC content in three studies [ 23 , 28 , 36 ], greater platelet content in one study [ 46 ], and no significant associations were found in two studies [ 16 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…A total of nine studies [ 13 , 19 , 21 , 34 , 35 , 40 , 43 , 45 , 46 ] reported on the influence of bridging thrombolysis on fibrin content. Two studies [ 39 , 44 ] found an association with lower fibrin content, one study [ 49 ] with higher fibrin content, and six studies [ 13 , 19 , 21 , 34 , 43 , 46 ] with no significant association.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Is Composition of Brain Clot Retrieved by Mechanical Thrombectomy Associated with Stroke Aetiology and Clinical Outcomes in Acute Ischemic Stroke?—A Systematic Review and Meta-Analysis

Huang

Killingsworth

Bhaskar

2022

Neurology International

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Background: Brain clots retrieved following endovascular thrombectomy in acute ischemic stroke patients may offer unique opportunities to characterise stroke aetiology and aid stroke decision-making in select groups of patients. However, the evidence around the putative association of clot morphology with stroke aetiology is limited and remains inconclusive. This study aims to perform a systematic review and meta-analysis to delineate the association of brain clot composition with stroke aetiology and post-reperfusion outcomes in patients receiving endovascular thrombectomy. Methods: The authors conducted a systematic literature review and meta-analysis by extracting data from several research databases (MEDLINE/PubMed, Cochrane, and Google Scholar) published since 2010. We used appropriate key search terms to identify clinical studies concerning stroke thrombus composition, aetiology, and clinical outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The authors identified 30 articles reporting on the relationship between stroke thrombus composition or morphology and aetiology, imaging, or clinical outcomes, of which 21 were included in the meta-analysis. The study found that strokes of cardioembolic origin (SMD = 0.388; 95% CI, 0.032–0.745) and cryptogenic origin (SMD = 0.468; 95% CI, 0.172–0.765) had significantly higher fibrin content than strokes of non-cardioembolic origin. Large artery atherosclerosis strokes had significantly lower fibrin content than cardioembolic (SMD = 0.552; 95% CI, 0.099–1.004) or cryptogenic (SMD = 0.455; 95% CI, 0.137–0.774) strokes. Greater red blood cell content was also significantly associated with a thrombolysis in cerebral infarction score of 2b–3 (SMD = 0.450; 95% CI, 0.177–0.722), and a positive hyperdense middle cerebral artery sign (SMD = 0.827; 95% CI, 0.472–1.183). No significant associations were found between red blood cell, platelet, or white blood cell content and aetiology, or between clot composition and bridging thrombolysis. Conclusions: This meta-analysis found that fibrin composition is significantly higher in strokes of cardioembolic and cryptogenic origin, and that red blood cell content is positively associated with the hyperdense middle cerebral artery sign and better reperfusion outcomes. Important advances to stroke clinical workup can be derived from these findings, in which many aspects of stroke workflow remain to be optimised. As data are still limited in terms of the association of various thrombus components with stroke aetiology as well as a standardised method of analysis, further studies are required to validate these findings to guide their use in clinical decision-making.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Is Composition of Brain Clot Retrieved by Mechanical Thrombectomy Associated with Stroke Aetiology and Clinical Outcomes in Acute Ischemic Stroke?—A Systematic Review and Meta-Analysis

Huang

Killingsworth

Bhaskar

2022

Neurology International

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“…Several studies have reported that RBC-rich clots are associated with a non-cardioembolic cause, often LAA [ 32 , 34 , 35 , 40 , 44 ]. Significant radiological features of RBC-rich clots are: HMCAS [ 39 , 40 , 42 , 44 , 50 , 54 ] and susceptibility vessel sign (SVS) [ 37 , 53 , 80 ].…”

Section: Clot Componentsmentioning

confidence: 99%

“…Moreover, whether these signs are clinically significant or not is contested. Various studies, including a systematic review, concluded that the HMCAS was associated with successful recanalization [ 80 , 96 , 97 ], though a smaller study by Ye et al reported no significant association [ 39 ]. Their results may have been affected by the small sample size and limited by only studying patient cases with retrievable clot specimens.…”

Section: Clot Composition and Imagingmentioning

confidence: 99%

Clot Morphology in Acute Ischemic Stroke Decision Making

Huang

Bhaskar

2022

IJMS

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Stroke is a leading cause of death and disability in the world, and the provision of reperfusion therapy and endovascular therapy, in particular, have revolutionized the treatment of patients with stroke and opened opportunities to look at brain clots retrieved after the procedure. The use of histopathology and molecular profiling of clots is of growing research and clinical interest. However, its clinical implications and incorporation within stroke workflows remain suboptimal. Recent studies have indicated that the study of brain clots may inform the mechanism of stroke and hence guide treatment decision-making in select groups of patients, especially patients without a defined cause or known mechanism. This article provides a comprehensive overview of various clot histopathological examinations in acute stroke-care settings, their clinical utility, and existing gaps and opportunities for further research. We also provide targeted recommendations to improve clot analysis workflow, hence standardizing its incorporation into clinical practice.

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A nomogram for predicting thrombus composition in stroke patients with large vessel occlusion: combination of thrombus density and perviousness with clinical features

et al. 2022

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Histological composition behind CT-based thrombus density and perviousness in acute ischemic stroke

Cited by 16 publications

References 34 publications

Is Composition of Brain Clot Retrieved by Mechanical Thrombectomy Associated with Stroke Aetiology and Clinical Outcomes in Acute Ischemic Stroke?—A Systematic Review and Meta-Analysis

Is Composition of Brain Clot Retrieved by Mechanical Thrombectomy Associated with Stroke Aetiology and Clinical Outcomes in Acute Ischemic Stroke?—A Systematic Review and Meta-Analysis

Clot Morphology in Acute Ischemic Stroke Decision Making

A nomogram for predicting thrombus composition in stroke patients with large vessel occlusion: combination of thrombus density and perviousness with clinical features

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