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Akkipeddi SMK, Rahmani R, Ellens NR, Kohli GS, Houk C, Schartz DA, Chittaranjan S, Worley L, Gunturi A, Bhalla T, Mattingly TK, Welle K, Morrell CN, Bender MT. Histone content, and thus DNA content, is associated with differential in vitro lysis of acute ischemic stroke clots. J Thromb Haemost 2024; 22:1410-1420. [PMID: 38296159 DOI: 10.1016/j.jtha.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/15/2023] [Accepted: 01/09/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Fibrin, von Willebrand factor, and extracellular DNA from neutrophil extracellular traps all contribute to acute ischemic stroke thrombus integrity. OBJECTIVES In this study, we explored how the proteomic composition of retrieved thromboemboli relates to susceptibility to lysis with distinct thrombolytics. METHODS Twenty-six retrieved stroke thromboemboli were portioned into 4 segments, with each subjected to 1 hour of in vitro lysis at 37 °C in 1 of 4 solutions: tissue plasminogen activator (tPA), tPA + von Willebrand factor-cleaving ADAMTS-13, tPA + DNA-cleaving deoxyribonuclease (DNase) I, and all 3 enzymes. Lysis, characterized by the percent change in prelysis and postlysis weight, was compared across the solutions and related to the corresponding abundance of proteins identified on mass spectrometry for each of the thromboemboli used in lysis. RESULTS Solutions containing DNase resulted in approximately 3-fold greater thrombolysis than that with the standard-of-care tPA solution (post hoc Tukey, P < .01 for all). DNA content was directly related to lysis in solutions containing DNase (Spearman's ρ > 0.39 and P < .05 for all significant histones) and inversely related to lysis in solutions without DNase (Spearman's ρ < -0.40 and P < .05 for all significant histones). Functional analysis suggests distinct pathways associated with susceptibility to thrombolysis with tPA (platelet-mediated) or DNase (innate immune system-mediated). CONCLUSION This study demonstrates synergy of DNase and tPA in thrombolysis of stroke emboli and points to DNase as a potential adjunct to our currently limited selection of thrombolytics in treating acute ischemic stroke.
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Affiliation(s)
- Sajal Medha K Akkipeddi
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA. https://twitter.com/SajalAkkipeddi
| | - Redi Rahmani
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Nathaniel R Ellens
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Gurkirat S Kohli
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Clifton Houk
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Derrek A Schartz
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA. https://twitter.com/D_SchartzMD
| | - Siddharth Chittaranjan
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Logan Worley
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Aditya Gunturi
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Tarun Bhalla
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas K Mattingly
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin Welle
- Mass Spectrometry Resource Laboratory, University of Rochester Medical Center, Rochester, New York, USA
| | - Craig N Morrell
- Aab Cardiovascular Research Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA.
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Jiang Y, Sun Z, Ge Z, Tao Z, Liu M, Zhong W, Dong N, Xu L, Wang H, Xu Y, Shen X. Differential expression of Semaphorin-7A /CD163-positive macrophages in large artery and cardiogenic stroke. BMC Neurol 2024; 24:70. [PMID: 38373967 PMCID: PMC10875813 DOI: 10.1186/s12883-024-03559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Identification of the causes of stroke of undetermined etiology, specifically cardioembolism (CE) and non-CE causes, can inform treatment planning and prognosis prediction. The objective of this study was to analyze the disparities in thrombus composition, particularly Semaphorin-7A (Sema7A) and CD163, between patients diagnosed with large-artery atherosclerosis (LAA) and those with CE, and to investigate their potential association with prognosis. METHODS Thrombi were collected from patients who underwent mechanical thrombectomy at two hospitals. The patients were categorized into two groups: LAA and CE. We compared the levels of Sema7A and CD163 between these groups and analyzed their relationships with stroke severity, hemorrhagic transformation and prognosis. RESULTS The study involved a total of 67 patients. Sema7A expression was found to be significantly higher in the CE group compared to LAA (p < 0.001). Conversely, no statistically significant differences were observed for CD163 between the groups. The presence of Sema7A/CD163 did not show any associations with stroke severity or hemorrhagic transformation (all p > 0.05). However, both Sema7A (OR, 2.017; 95% CI, 1.301-3.518; p = 0.005) and CD163 (OR, 2.283; 95% CI, 1.252-5.724; p = 0.03) were associated with the poor prognosis for stroke, after adjusting for stroke severity. CONCLUSION This study highlights that CE thrombi exhibited higher levels of Sema7A expression compared to LAA thrombi. Moreover, we found a positive correlation between Sema7A/CD163 levels and the poor prognosis of patients with acute ischemic stroke.
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Affiliation(s)
- Yi Jiang
- Department of Geriatrics, Bengbu Medical College Clinical College of Lianyungang Second People's Hospital, Lianyungang, 222000, China
| | - Zhichao Sun
- Department of Pathology, Lianyungang Second People's Hospital, Lianyungang, 222000, China
| | - Zhonglin Ge
- Department of Neurology, Lianyungang Second People's Hospital, Lianyungang, 222000, China.
| | - Zhonghai Tao
- Department of Neurology, Lianyungang Second People's Hospital, Lianyungang, 222000, China
| | - Mengqian Liu
- Department of Geriatrics, Lianyungang Hospital Affiliated to Jiangsu University, Lianyungang, 222000, China
| | - Wen Zhong
- Department of Geriatrics, Lianyungang Hospital Affiliated to Jiangsu University, Lianyungang, 222000, China
| | - Nan Dong
- Department of Neurology, Shaoxing Central Hospital, Shaoxing, China
| | - Lei Xu
- Department of Pathology, Lianyungang Second People's Hospital, Lianyungang, 222000, China
| | - Hui Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiwen Xu
- Department of Infectious Disease, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Xiaozhu Shen
- Department of Geriatrics, Bengbu Medical College Clinical College of Lianyungang Second People's Hospital, Lianyungang, 222000, China.
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3
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Jabrah D, Rossi R, Molina S, Douglas A, Pandit A, McCarthy R, Gilvarry M, Ceder E, Fitzgerald S, Dunker D, Nordanstig A, Redfors P, Tatlisumak T, O'Hare A, Power S, Brennan P, Owens P, Nagy A, Vadász Á, De Meyer SF, Tsivgoulis G, Psychogios K, Szikora I, Jood K, Rentzos A, Thornton J, Doyle K. White blood cell subtypes and neutrophil extracellular traps content as biomarkers for stroke etiology in acute ischemic stroke clots retrieved by mechanical thrombectomy. Thromb Res 2024; 234:1-8. [PMID: 38113606 DOI: 10.1016/j.thromres.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Lymphocytes, macrophages, neutrophils, and neutrophil extracellular traps (NETs) associate with stroke risk factors and form a thrombus through different mechanisms. We investigated the total WBCs, WBC subtypes and NETs composition in acute ischemic stroke (AIS) clots to identify possible etiological differences that could help us further understand the process of thrombosis that leads to AIS. METHODS AIS clots from 100 cases each of atherothrombotic (AT), cardioembolic (CE) and cryptogenic stroke etiology were collected per-pass as part of the CÚRAM RESTORE registry of AIS clots. Martius Scarlet Blue stain was used to identify the main histological components of the clots. Immunohistochemical staining was used to identify neutrophils, lymphocytes, macrophages, and NETs patterns. The cellular and histological components were quantified using Orbit Image Analysis software. RESULTS AT clots were larger, with more red blood cells and fewer WBCs than CE clots. AT clots had more lymphocytes and cryptogenic clots had fewer macrophages than other etiologies. Most significantly, CE clots showed higher expression of neutrophils and extracellular web-like NETs compared to AT and cryptogenic clots. There was also a significantly higher distribution of web-like NETs around the periphery of the CE clots while a mixed distribution was observed in AT clots. CONCLUSION The difference in neutrophil and NETs expression in clots from different etiologies may provide insight into the mechanism of clot formation.
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Affiliation(s)
- Duaa Jabrah
- Department of Physiology, University of Galway, Galway, Ireland
| | - Rosanna Rossi
- Department of Physiology, University of Galway, Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, University of Galway, Galway, Ireland
| | - Sara Molina
- Department of Physiology, University of Galway, Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, University of Galway, Galway, Ireland
| | - Andrew Douglas
- Department of Physiology, University of Galway, Galway, Ireland
| | - Abhay Pandit
- CÚRAM-SFI Centre for Research in Medical Devices, University of Galway, Galway, Ireland
| | - Ray McCarthy
- Cerenovus, Galway Neuro Technology Centre, Galway, Ireland
| | | | - Eric Ceder
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Department of Radiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Seán Fitzgerald
- Department of Physiology, University of Galway, Galway, Ireland
| | - Dennis Dunker
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Department of Radiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Annika Nordanstig
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alan O'Hare
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Sarah Power
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Paul Brennan
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Peter Owens
- Centre for Microscopy and Imaging, University of Galway, Galway, Ireland
| | - András Nagy
- Department of Neurointerventions, National Institute of Neurosciences, Budapest, Hungary
| | - Ágnes Vadász
- Department of Neurointerventions, National Institute of Neurosciences, Budapest, Hungary
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | | | - Istvan Szikora
- Department of Neurointerventions, National Institute of Neurosciences, Budapest, Hungary
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alexandros Rentzos
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Department of Radiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - John Thornton
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Karen Doyle
- Department of Physiology, University of Galway, Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, University of Galway, Galway, Ireland.
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Vandelanotte S, De Meyer SF. Acute Ischemic Stroke Thrombus Composition. Neuroscience 2024:S0306-4522(23)00551-1. [PMID: 38185279 DOI: 10.1016/j.neuroscience.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
Ischemic stroke is caused by a thrombus blocking one or multiple arteries in the brain, resulting in irreversible damage in the associated brain tissue. The aim of therapy is to restore the blood flow as fast as possible. Two recanalization strategies are currently available: pharmacological thrombolysis using recombinant tissue plasminogen activator (rt-PA) and mechanical removal of the thrombus. Despite recent advancements, achieving efficient recanalization remains a challenge. The precise causes of therapy failure are not fully understood but thrombus composition is likely a key factor in successful recanalization. This review explores acute ischemic stroke thrombus composition, its recently identified components, and how it affects stroke treatment. It also discusses how new insights could enhance current recanalization strategies for ischemic stroke patients.
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Affiliation(s)
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium.
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5
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Tutino VM, Fricano S, Chien A, Patel TR, Monteiro A, Rai HH, Dmytriw AA, Chaves LD, Waqas M, Levy EI, Poppenberg KE, Siddiqui AH. Gene expression profiles of ischemic stroke clots retrieved by mechanical thrombectomy are associated with disease etiology. J Neurointerv Surg 2023; 15:e33-e40. [PMID: 35750484 PMCID: PMC9789205 DOI: 10.1136/neurintsurg-2022-018898] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/06/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Determining stroke etiology is crucial for secondary prevention, but intensive workups fail to classify ~30% of strokes that are cryptogenic. OBJECTIVE To examine the hypothesis that the transcriptomic profiles of clots retrieved during mechanical thrombectomy are unique to strokes of different subtypes. METHODS We isolated RNA from the clots of 73 patients undergoing mechanical thrombectomy. Samples of sufficient quality were subjected to 100-cycle, paired-end RNAseq, and transcriptomes with less than 10 million unique reads were excluded from analysis. Significant differentially expressed genes (DEGs) between subtypes (defined by the Trial of Org 10 172 in Acute Stroke Treatment) were identified by expression analysis in edgeR. Gene ontology enrichment analysis was used to study the biologic differences between stroke etiologies. RESULTS In all, 38 clot transcriptomes were analyzed; 6 from large artery atherosclerosis (LAA), 21 from cardioembolism (CE), 5 from strokes of other determined origin, and 6 from cryptogenic strokes. Among all comparisons, there were 816 unique DEGs, 174 of which were shared by at least two comparisons, and 20 of which were shared by all three. Gene ontology analysis showed that CE clots reflected high levels of inflammation, LAA clots had greater oxidoreduction and T-cell processes, and clots of other determined origin were enriched for aberrant platelet and hemoglobin-related processes. Principal component analysis indicated separation between these subtypes and showed cryptogenic samples clustered among several different groups. CONCLUSIONS Expression profiles of stroke clots were identified between stroke etiologies and reflected different biologic responses. Cryptogenic thrombi may be related to multiple etiologies.
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Affiliation(s)
- Vincent M Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo School of Engineering and Applied Sciences, Buffalo, New York, USA
- Department of Biomedical Engineering, University at Buffalo School of Engineering and Applied Sciences, Buffalo, New York, USA
| | - Sarah Fricano
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Aichi Chien
- Department of Radiological Sciences, UCLA, Los Angeles, California, USA
| | - Tatsat R Patel
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo School of Engineering and Applied Sciences, Buffalo, New York, USA
| | - Andre Monteiro
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Hamid H Rai
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neuroradiology and Neurointervention, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lee D Chaves
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kerry E Poppenberg
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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6
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Hund HM, Boodt N, Hansen D, Haffmans WA, Lycklama À Nijeholt GJ, Hofmeijer J, Dippel DWJ, van der Lugt A, van Es ACGM, van Beusekom HMM, Roos YBWEM, van Oostenbrugge RJ, van Zwam WH, Boiten J, Vos JA, Jansen IGH, Mulder MJHL, Goldhoorn RJB, Compagne KCJ, Kappelhof M, Brouwer J, den Hartog SJ, Hinsenveld WH, Roozenbeek B, Emmer BJ, Coutinho JM, Schonewille WJ, Wermer MJH, van Walderveen MAA, Staals J, Martens JM, de Bruijn SF, van Dijk LC, van der Worp HB, Lo RH, van Dijk EJ, Boogaarts HD, de Vries J, de Kort PLM, van Tuijl J, Peluso JP, Fransen P, van den Berg JSP, van Hasselt BAAM, Aerden LAM, Dallinga RJ, Uyttenboogaart M, Eschgi O, Bokkers RPH, Schreuder THCML, Heijboer RJJ, Keizer K, Yo LSF, den Hertog HM, Bulut T, Brouwers PJAM, Sprengers MES, Jenniskens SFM, van den Berg R, Yoo AJ, Beenen LFM, Postma AA, Roosendaal SD, van der Kallen BFW, van den Wijngaard IR, Bot J, van Doormaal PJ, Meijer A, Ghariq E, van Proosdij MP, Krietemeijer GM, Dinkelaar W, Appelman APA, Hammer B, Pegge S, van der Hoorn A, Vinke S, Flach HZ, Lingsma HF, el Ghannouti N, Sterrenberg M, Pellikaan W, Sprengers R, Elfrink M, Simons M, Vossers M, de Meris J, Vermeulen T, Geerlings A, van Vemde G, Simons T, Messchendorp G, Nicolaij N, Bongenaar H, Bodde K, Kleijn S, Lodico J, Droste H, Wollaert M, Verheesen S, Jeurrissen D, Bos E, Drabbe Y, Sandiman M, Aaldering N, Zweedijk B, Vervoort J, Ponjee E, Romviel S, Kanselaar K, Barning D, Venema E, Chalos V, Geuskens RR, van Straaten T, Ergezen S, Harmsma RRM, Muijres D, de Jong A, Berkhemer OA, Boers AMM, Huguet J, Groot PFC, Mens MA, van Kranendonk KR, Treurniet KM, Tolhuisen ML, Alves H, Weterings AJ, Kirkels EL, Voogd EJHF, Schupp LM, Collette SL, Groot AED, LeCouffe NE, Konduri PR, Prasetya H, Arrarte-Terreros N, Ramos LA. Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank. Neuroradiology 2023; 65:933-943. [PMID: 36695859 PMCID: PMC10105654 DOI: 10.1007/s00234-023-03115-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. METHODS The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. RESULTS The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00-1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00-1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. CONCLUSION Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.
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Affiliation(s)
- Hajo M Hund
- Department of Cardiology, Erasmus MC University Medical Center, Room EE23.93, PO 2040, 3000CA, Rotterdam, The Netherlands.,Department of Radiology, Haaglanden Medical Centrum, The Hague, The Netherlands
| | - Nikki Boodt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Daniel Hansen
- Department of Cardiology, Erasmus MC University Medical Center, Room EE23.93, PO 2040, 3000CA, Rotterdam, The Netherlands
| | - Willem A Haffmans
- Department of Cardiology, Erasmus MC University Medical Center, Room EE23.93, PO 2040, 3000CA, Rotterdam, The Netherlands
| | | | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adriaan C G M van Es
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Heleen M M van Beusekom
- Department of Cardiology, Erasmus MC University Medical Center, Room EE23.93, PO 2040, 3000CA, Rotterdam, The Netherlands.
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7
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Cha MJ, Ha J, Lee H, Kwon I, Kim S, Kim YD, Nam HS, Lee HS, Song TJ, Choi HJ, Heo JH. Neutrophil Recruitment in Arterial Thrombus and Characteristics of Stroke Patients with Neutrophil-Rich Thrombus. Yonsei Med J 2022; 63:1016-1026. [PMID: 36303310 PMCID: PMC9629897 DOI: 10.3349/ymj.2022.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Neutrophils contribute to thrombosis. However, there is limited information on the temporal course of neutrophil recruitment in thrombosis, the contribution of neutrophils to thrombus growth, and the characteristics of stroke patients with neutrophil-rich thrombi. MATERIALS AND METHODS After inducing carotid artery thrombosis in Institute of Cancer Research mice using ferric chloride, aged thrombi were produced by ligating the distal portion of the carotid artery in mice for 0.5, 1, 2, 3, 6, or 24 h. For thrombus analysis in stroke patients, we used registry data and thrombi that were obtained during intra-arterial thrombectomy. Immunohistochemistry was performed to determine thrombus composition. RESULTS In the thrombi of 70 mice, Ly6G positive cell counts (neutrophils) and histone H3-positive cell counts increased in a time-dependent manner (both p<0.001). Ly6G-positive cell count was strongly correlated with histone H3-positive cell counts (r=0.910, p<0.001), but not with thrombus size (p=0.320). In 75 stroke patients, atrial fibrillation and cardioembolism were more frequent in the higher neutrophil group (32/37, 86.5%) than in the lower neutrophil group (19/38, 50%) (p=0.002). The median erythrocyte fraction was higher [52.0 (interquartile range 39.9-57.8)] in the higher neutrophil group than in the lower neutrophil group [40.3 (interquartile range 23.5-53.2)]. The fraction of neutrophils was positively correlated with that of erythrocytes (R=0.35, p=0.002). CONCLUSION Neutrophils were recruited and increased in arterial thrombosis in a time-dependent manner; however, they were not associated with the growth of formed thrombi. Neutrophil fractions in the thrombi of stroke patients appeared to be associated with atrial fibrillation and erythrocyte fraction.
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Affiliation(s)
- Myoung-Jin Cha
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, National Police Hospital, Seoul, Korea
| | - Jimin Ha
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Il Kwon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sungeun Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyun-Jung Choi
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea.
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8
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Gilbert A, Detraz L, Alexandre PL, Serfaty JM, Desal H, Toquet C, Bourcier R. Magnetic resonance imaging quantitative T2* mapping to predict the red blood cell content of in vivo thrombi retrieved from patients with large vessel occlusions in acute ischemic stroke. Interv Neuroradiol 2022; 28:523-530. [PMID: 34559000 PMCID: PMC9511618 DOI: 10.1177/15910199211042473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance imaging quantitative T2* mapping has shown reliable identification of thrombus red blood cell content in vitro. The thrombus composition has been in vivo, associated with outcomes after endovascular therapy for acute ischemic stroke. We aim to analyze the red blood cell content of thrombi retrieved from patients with large vessel occlusions in relation to the thrombus-T2* relaxation time in magnetic resonance imaging. MATERIAL AND METHODS Consecutive acute ischemic stroke patients treated by endovascular therapy were scanned with an magnetic resonance imaging quantitative T2* mapping sequence. Quantitative histologic evaluations of red blood cell content were performed. A linear regression assessed the association between vascular risk factors, comorbidities, antithrombotic drugs intake, baseline National Institutes of Health Stroke Scale (NIHSS), intravenous thrombolysis before endovascular therapy, time between onset and groin puncture, patient's outcome at 3 months, magnetic resonance imaging quantitative T2* mapping results, and the red blood cell content of thrombi. The correlation between the mean thrombus-T2* relaxation time and red blood cell content was assessed by calculating the Pearson correlation coefficient. RESULTS Among 31 thrombi, 16 were "Fibrin rich" and 15 "red blood cell dominant." The median red blood cell content was 39 (range, 0-90; interquartile range, 37). The median (interquartile range) thrombus-T2* relaxation time was shorter in "red blood cell dominant" thrombi (21, interquartile range 6) than in "Fibrin rich" thrombi (24, interquartile range 7), without significant difference (p = 0.15), as shown in the Box plot. An inverse correlation between thrombus-T2* relaxation time and red blood cell content was found, with a correlation coefficient of -0.41 (95% CI, -0.67 to -0.08, p = 0.02). CONCLUSION Our study shows that a shorter thrombus-T2* relaxation time is related to a higher red blood cell content within in vivo thrombi.
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Affiliation(s)
- Alize Gilbert
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Lili Detraz
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Pierre-Louis Alexandre
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Jean-Michel Serfaty
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Hubert Desal
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Claire Toquet
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
| | - Romain Bourcier
- l'institut du thorax Université de Nantes, CHU Nantes, INSERM, CNRS, Nantes, France
- CHU Nantes, Department of Neuroradiology, Nantes, France
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9
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Wang R, Wang Z, Jiang L, Gu G, Zheng B, Xian L, Zhang Y, Wang J. High Actin Expression in Thrombus of Acute Ischemic Stroke Can Be a Biomarker of Atherothrombotic Origin Stroke. Front Neurol 2022; 13:896428. [PMID: 35937070 PMCID: PMC9355373 DOI: 10.3389/fneur.2022.896428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background As 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 Methods A 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. Results A 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). Conclusion Our findings suggest that actin's level was a major factor differentiating atherothrombotic origin strokes from the cardioembolic stroke. Clinical Trial Registration ChiCTR2100051173.
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Affiliation(s)
- Rongyu Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhiqiang Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Neurology, Chengdu BOE Hospital, Chengdu, China
| | - Lianyan Jiang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Gangfeng Gu
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Bo Zheng
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Liulin Xian
- Acupuncture and Tuina College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yaodan Zhang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian Wang
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
- *Correspondence: Jian Wang
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10
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Mereuta OM, Abbasi M, Arturo Larco JL, Dai D, Liu Y, Arul S, Kadirvel R, Hanel RA, Yoo AJ, Almekhlafi MA, Layton KF, Delgado Almandoz JE, Kvamme P, Mendes Pereira V, Jahromi BS, Nogueira RG, Gounis MJ, Patel B, Aghaebrahim A, Sauvageau E, Bhuva P, Soomro J, Demchuk AM, Thacker IC, Kayan Y, Copelan A, Nazari P, Cantrell DR, Haussen DC, Al-Bayati AR, Mohammaden M, Pisani L, Rodrigues GM, Puri AS, Entwistle J, Meves A, Savastano L, Cloft HJ, Nimjee SM, McBane Ii RD, Kallmes DF, Brinjikji W. Correlation of von Willebrand factor and platelets with acute ischemic stroke etiology and revascularization outcome: an immunohistochemical study. J Neurointerv Surg 2022; 15:488-494. [PMID: 35595407 DOI: 10.1136/neurintsurg-2022-018645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Platelets and von Willebrand factor (vWF) are key components of acute ischemic stroke (AIS) emboli. We aimed to investigate the CD42b (platelets)/vWF expression, its association with stroke etiology and the impact these components may have on the clinical/procedural parameters. METHODS CD42b/vWF immunostaining was performed on 288 emboli collected as part of the multicenter STRIP Registry. CD42b/VWF expression and distribution were evaluated. Student's t-test and χ2 test were performed as appropriate. RESULTS The mean CD42b and VWF content in clots was 44.3% and 21.9%, respectively. There was a positive correlation between platelets and vWF (r=0.64, p<0.001**). We found a significantly higher vWF level in the other determined etiology (p=0.016*) and cryptogenic (p=0.049*) groups compared with cardioembolic etiology. No significant difference in CD42b content was found across the etiology subtypes. CD42b/vWF patterns were significantly associated with stroke etiology (p=0.006*). The peripheral pattern was predominant in atherosclerotic clots (36.4%) while the clustering (patchy) pattern was significantly associated with cardioembolic and cryptogenic origin (66.7% and 49.8%, respectively). The clots corresponding to other determined etiology showed mainly a diffuse pattern (28.1%). Two types of platelets were distinguished within the CD42b-positive clusters in all emboli: vWF-positive platelets were observed at the center, surrounded by vWF-negative platelets. Thrombolysis correlated with a high platelet content (p=0.03*). vWF-poor and peripheral CD42b/vWF pattern correlated with first pass effect (p=0.03* and p=0.04*, respectively). CONCLUSIONS The vWF level and CD42b/vWF distribution pattern in emboli were correlated with AIS etiology and revascularization outcome. Platelet content was associated with response to thrombolysis.
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Affiliation(s)
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorge L Arturo Larco
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Santhosh Arul
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Albert J Yoo
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Josser E Delgado Almandoz
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Peter Kvamme
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Vitor Mendes Pereira
- Departments of Medical Imaging and Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Babak S Jahromi
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - Biraj Patel
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Amin Aghaebrahim
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Parita Bhuva
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Jazba Soomro
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ike C Thacker
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Alexander Copelan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pouya Nazari
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Donald Robert Cantrell
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Mahmoud Mohammaden
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Gabriel Martins Rodrigues
- Department of Neurology, Emory University, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - John Entwistle
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid M Nimjee
- Department of Neurological Surgery, Ohio State University, Columbus, Ohio, USA
| | - Robert D McBane Ii
- Gonda Vascular Center, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Patil S, Darcourt J, Messina P, Bozsak F, Cognard C, Doyle K. Characterising acute ischaemic stroke thrombi: insights from histology, imaging and emerging impedance-based technologies. Stroke Vasc Neurol 2022; 7:353-363. [PMID: 35241632 PMCID: PMC9453827 DOI: 10.1136/svn-2021-001038] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
Abstract
Treatment of acute ischaemic stroke (AIS) focuses on rapid recanalisation of the occluded artery. In recent years, advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retrieved during the endovascular thrombectomy procedure. Despite ongoing developments and progress in AIS imaging techniques, it is not yet possible to conclude definitively regarding thrombus characteristics that could advise on the probable efficacy of thrombolysis or thrombectomy in advance of treatment. Intraprocedural devices with dignostic capabilities or new clinical imaging approaches are needed for better treatment of AIS patients. In this review, what is known about the composition of the thrombi that cause strokes and the evidence that thrombus composition has an impact on success of acute stroke treatment has been examined. This review also discusses the evidence that AIS thrombus composition varies with aetiology, questioning if suspected aetiology could be a useful indicator to stroke physicians to help decide the best acute course of treatment. Furthermore, this review discusses the evidence that current widely used radiological imaging tools can predict thrombus composition. Further use of new emerging technologies based on bioimpedance, as imaging modalities for diagnosing AIS and new medical device tools for detecting thrombus composition in situ has been introduced. Whether bioimpedance would be beneficial for gaining new insights into in situ thrombus composition that could guide choice of optimum treatment approach is also reviewed.
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Affiliation(s)
- Smita Patil
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | - Karen Doyle
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland .,Physiology, National University of Ireland Galway, Galway, Ireland
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12
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Staessens S, François O, Brinjikji W, Doyle KM, Vanacker P, Andersson T, De Meyer SF. Studying Stroke Thrombus Composition After Thrombectomy: What Can We Learn? Stroke 2021; 52:3718-3727. [PMID: 34517770 PMCID: PMC8545837 DOI: 10.1161/strokeaha.121.034289] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The composition of ischemic stroke thrombi has gained an increasing amount of interest in recent years. The implementation of endovascular procedures in standard stroke care has granted researchers the unique opportunity to examine patient thrombus material. Increasing evidence indicates that stroke thrombi are complex and heterogenous, consisting of various biochemical (eg, fibrin, von Willebrand Factor, and neutrophil extracellular traps) and cellular (eg, red blood cells, platelets, leukocytes, and bacteria) components. This complex composition may explain therapeutic limitations and also offer novel insights in several aspects of stroke management. Better understanding of thrombus characteristics could, therefore, potentially lead to improvements in the management of patients with stroke. In this review, we provide a comprehensive overview of the lessons learned by examining stroke thrombus composition after endovascular thrombectomy and its potential relevance for thrombectomy success rates, thrombolysis, clinical outcomes, stroke etiology, and radiological imaging.
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Affiliation(s)
- Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | | | | | - Karen M. Doyle
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Peter Vanacker
- Department of Neurology, AZ Groeninge, Kortrijk, Belgium
- Department of Neurology, University Hospitals Antwerp, Antwerp, Belgium
- Department of Translational Neuroscience, University of Antwerp, Antwerp, Belgium
| | - Tommy Andersson
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon F. De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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13
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Juega J, Palacio-Garcia C, Rodriguez M, Deck M, Rodriguez-Luna D, Requena M, García-Tornel Á, Rodriguez-Villatoro N, Rubiera M, Boned S, Muchada M, Ribo M, Pinana C, Hernandez D, Coscojuela P, Diaz H, Sanjuan E, Hernandez-Perez M, Dorado L, Quesada H, Cardona P, De-La-Torre C, Tomasello A, Gallur L, Sanchez M, Gonzalez-Rubio S, Camacho J, Ramon-Y-Cajal S, Álvarez-Sabin J, Molina CA, Pagola J. Monocyte-to-Lymphocyte Ratio in Clot Analysis as a Marker of Cardioembolic Stroke Etiology. Transl Stroke Res 2021; 13:949-958. [PMID: 34586594 DOI: 10.1007/s12975-021-00946-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022]
Abstract
The aim of the study was to find markers of high-risk cardioembolic etiology (HRCE) in patients with cryptogenic strokes (CS) through the analysis of intracranial clot by flow cytometry (FC). A prospective single-center study was designed including patients with large vessel occlusion strokes. The percentage of granulocytes, monocytes, lymphocytes, and monocyte-to-lymphocyte ratio (MLr) were analyzed in clots extracted after endovascular treatment (EVT) and in peripheral blood. Large arterial atherosclerosis (LAA) strokes and high-risk cardioembolic (HRCE) strokes were matched by demographics and acute reperfusion treatment data to obtain FC predictors for HRCE. Multilevel decision tree with boosting random forest classifiers was performed with each feature importance for HRCE diagnosis among CS. We tested the validity of the best FC predictor in a cohort of CS that underwent extensive diagnostic workup. Among 211 patients, 178 cases underwent per-protocol workup. The percentage of monocytes (OR 1.06, 95% CI 1.01-1.11) and MLr (OR 1.83, 95% CI 1.12-2.98) independently predicted HRCE diagnosis when LAA clots (n = 28) were matched with HRCE clots (n = 28). Among CS (n = 82), MLr was the feature with the highest weighted importance in the multilevel decision tree as a predictor for HRCE. MLr cutoff point of 1.59 yield sensitivity of 91.23%, specificity of 44%, positive predictive value of 78.79%, and negative predictive value of 68.75 for HRCE diagnosis among CS. MLr ≥ 1.6 in clot analysis predicted HRCE diagnosis (OR, 6.63, 95% CI 1.85-23.71) in a multivariate model adjusted for age. Clot analysis by FC revealed high levels of monocyte-to-lymphocyte ratio as an independent marker of cardioembolic etiology in cryptogenic strokes.
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Affiliation(s)
- Jesús Juega
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Carlos Palacio-Garcia
- Hematology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Maite Rodriguez
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Matias Deck
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Álvaro García-Tornel
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Noelia Rodriguez-Villatoro
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Sandra Boned
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Carlos Pinana
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - David Hernandez
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Pilar Coscojuela
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Humberto Diaz
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Estela Sanjuan
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Maria Hernandez-Perez
- Stroke Unit, Department of Neurology, Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Laura Dorado
- Stroke Unit, Department of Neurology, Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Helena Quesada
- Stroke Unit Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Pere Cardona
- Stroke Unit Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Carolina De-La-Torre
- Stroke Unit Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Laura Gallur
- Hematology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Maria Sanchez
- Hematology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Sara Gonzalez-Rubio
- Hematology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Jessica Camacho
- Department of Pathology Vall d, Hebron University Hospital, Barcelona, Spain
| | | | - José Álvarez-Sabin
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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14
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Aliena-Valero A, Baixauli-Martín J, Torregrosa G, Tembl JI, Salom JB. Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review. J Stroke 2021; 23:327-342. [PMID: 34649378 PMCID: PMC8521257 DOI: 10.5853/jos.2021.02306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
Mechanical thrombectomy renders the occluding clot available for analysis. Insights into thrombus composition could help establish the stroke cause. We aimed to investigate the value of clot composition analysis as a complementary diagnostic tool in determining the etiology of large vessel occlusion (LVO) ischemic strokes (International Prospective Register of Systematic Reviews [PROSPERO] registration # CRD42020199436). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we ran searches on Medline (using the PubMed interface) and Web of Science for studies reporting analyses of thrombi retrieved from LVO stroke patients subjected to mechanical thrombectomy (January 1, 2006 to September 21, 2020). The PubMed search was updated weekly up to February 22, 2021. Reference lists of included studies and relevant reviews were hand-searched. From 1,714 identified studies, 134 eligible studies (97 cohort studies, 31 case reports, and six case series) were included in the qualitative synthesis. Physical, histopathological, biological, and microbiological analyses provided information about the gross appearance, mechanical properties, structure, and composition of the thrombi. There were non-unanimous associations of thrombus size, structure, and composition (mainly proportions of fibrin and blood formed elements) with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiology and underlying pathologies, and similarities between cryptogenic thrombi and those of known TOAST etiology. Individual thrombus analysis contributed to the diagnosis, mainly in atypical cases. Although cohort studies report an abundance of quantitative rates of main thrombus components, a definite clot signature for accurate diagnosis of stroke etiology is still lacking. Nevertheless, the qualitative examination of the embolus remains an invaluable tool for diagnosing individual cases, particularly regarding atypical stroke causes.
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Affiliation(s)
- Alicia Aliena-Valero
- Joint Cerebrovascular Research Unit, La Fe Health Research Institute, University of Valencia, Valencia, Spain
| | | | - Germán Torregrosa
- Joint Cerebrovascular Research Unit, La Fe Health Research Institute, University of Valencia, Valencia, Spain
| | - José I. Tembl
- Stroke Unit, Neurology Service, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Juan B. Salom
- Joint Cerebrovascular Research Unit, La Fe Health Research Institute, University of Valencia, Valencia, Spain
- Department of Physiology, University of Valencia, Valencia, Spain
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15
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Bi R, Chen S, Chen S, Peng Q, Jin H, Hu B. The role of leukocytes in acute ischemic stroke-related thrombosis: a notable but neglected topic. Cell Mol Life Sci 2021; 78:6251-6264. [PMID: 34398251 PMCID: PMC11072166 DOI: 10.1007/s00018-021-03897-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/15/2021] [Accepted: 07/02/2021] [Indexed: 12/19/2022]
Abstract
Ischemic stroke is one of the most serious diseases today, and only a minority of patients are provided with effective clinical treatment. Importantly, leukocytes have gradually been discovered to play vital roles in stroke thrombosis, including promoting the activation of thrombin and the adhesion and aggregation of platelets. However, they have not received enough attention in the field of acute ischemic stroke. It is possible that we could not only prevent stroke-related thrombosis by inhibiting leukocyte activation, but also target leukocyte components to dissolve thrombi in the cerebral artery. In this review, we expound the mechanisms by which leukocytes are activated and participate in the formation of stroke thrombus, then describe the histopathology of leukocytes in thrombi of stroke patients and the influence of leukocyte composition on vascular recanalization effects and patient prognosis. Finally, we discuss the relevant antithrombotic strategies targeting leukocytes.
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Affiliation(s)
- Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Shengcai Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Shaolin Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Qiwei Peng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
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16
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Marta-Enguita J, Navarro-Oviedo M, Muñoz R, Olier-Arenas J, Zalba G, Lecumberri R, Mendioroz M, Paramo JA, Roncal C, Orbe J. Inside the Thrombus: Association of Hemostatic Parameters With Outcomes in Large Vessel Stroke Patients. Front Neurol 2021; 12:599498. [PMID: 33692737 PMCID: PMC7937873 DOI: 10.3389/fneur.2021.599498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/14/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Actual clinical management of ischemic stroke (IS) is based on restoring cerebral blood flow using tissue plasminogen activator (tPA) and/or endovascular treatment (EVT). Mechanical thrombectomy has permitted the analysis of thrombus structural and cellular classic components. Nevertheless, histological assessment of hemostatic parameters such as thrombin-activatable fibrinolysis inhibitor (TAFI) and matrix metalloproteinase 10 (MMP-10) remains unknown, although their presence could determine thrombus stability and its response to thrombolytic treatment, improving patient's outcome. Methods: We collected thrombi (n = 45) from large vessel occlusion (LVO) stroke patients (n = 53) and performed a histological analysis of different hemostatic parameters [TAFI, MMP-10, von Willebrand factor (VWF), and fibrin] and cellular components (erythrocytes, leukocytes, macrophages, lymphocytes, and platelets). Additionally, we evaluated the association of these parameters with plasma levels of MMP-10, TAFI and VWF activity and recorded clinical variables. Results: In this study, we report for the first time the presence of MMP-10 and TAFI in all thrombi collected from LVO patients. Both proteins were localized in regions of inflammatory cells, surrounded by erythrocyte and platelet-rich areas, and their content was significantly associated (r = 0.41, p < 0.01). Thrombus TAFI was lower in patients who died during the first 3 months after stroke onset [odds ratio (OR) (95%CI); 0.59 (0.36–0.98), p = 0.043]. Likewise, we observed that thrombus MMP-10 was inversely correlated with the amount of VWF (r = −0.30, p < 0.05). Besides, VWF was associated with the presence of leukocytes (r = 0.37, p < 0.05), platelets (r = 0.32, p < 0.05), and 3 months mortality [OR (95%CI); 4.5 (1.2–17.1), p = 0.029]. Finally, plasma levels of TAFI correlated with circulating and thrombus platelets, while plasma MMP-10 was associated with cardiovascular risk factors and functional dependence at 3 months. Conclusions: The present study suggests that the composition and distribution of thrombus hemostatic components might have clinical impact by influencing the response to pharmacological and mechanical therapies as well as guiding the development of new therapeutic strategies.
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Affiliation(s)
- Juan Marta-Enguita
- Laboratory of Atherothrombosis, CIMA-Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain.,Neurology Service, Complejo Hospitalario de Navarra, IdisNA, Pamplona, Spain
| | - Manuel Navarro-Oviedo
- Laboratory of Atherothrombosis, CIMA-Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Roberto Muñoz
- Neurology Service, Complejo Hospitalario de Navarra, IdisNA, Pamplona, Spain.,Red de Investigación Cooperativa de Enfermedades Vasculares Cerebrales (INVICTUS PLUS), Madrid, Spain
| | - Jorge Olier-Arenas
- Radiology Service, Complejo Hospitalario de Navarra, IdisNA, Pamplona, Spain
| | - Guillermo Zalba
- Department of Biochemistry and Genetics, University of Navarra, IdiSNA, Pamplona, Spain
| | - Ramon Lecumberri
- Haematology Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maite Mendioroz
- Neurology Service, Complejo Hospitalario de Navarra, IdisNA, Pamplona, Spain.,Neuroepigenetics Laboratory-Navarrabiomed, Complejo-Hospitalario de Navarra, Universidad Pública de Navarra-UPNA, IdiSNA, Pamplona, Spain
| | - Jose A Paramo
- Laboratory of Atherothrombosis, CIMA-Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain.,Haematology Service, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Roncal
- Laboratory of Atherothrombosis, CIMA-Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain.,CIBER Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Josune Orbe
- Laboratory of Atherothrombosis, CIMA-Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain.,CIBER Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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17
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Dargazanli C, Zub E, Deverdun J, Decourcelle M, de Bock F, Labreuche J, Lefèvre PH, Gascou G, Derraz I, Riquelme Bareiro C, Cagnazzo F, Bonafé A, Marin P, Costalat V, Marchi N. Machine Learning Analysis of the Cerebrovascular Thrombi Proteome in Human Ischemic Stroke: An Exploratory Study. Front Neurol 2020; 11:575376. [PMID: 33240201 PMCID: PMC7678741 DOI: 10.3389/fneur.2020.575376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Mechanical retrieval of thrombotic material from acute ischemic stroke patients provides a unique entry point for translational research investigations. Here, we resolved the proteomes of cardioembolic and atherothrombotic cerebrovascular human thrombi and applied an artificial intelligence routine to examine protein signatures between the two selected groups. Methods: We specifically used n = 32 cardioembolic and n = 28 atherothrombotic diagnosed thrombi from patients suffering from acute stroke and treated by mechanical thrombectomy. Thrombi proteins were successfully separated by gel-electrophoresis. For each thrombi, peptide samples were analyzed by nano-flow liquid chromatography coupled to tandem mass spectrometry (nano-LC-MS/MS) to obtain specific proteomes. Relative protein quantification was performed using a label-free LFQ algorithm and all dataset were analyzed using a support-vector-machine (SVM) learning method. Data are available via ProteomeXchange with identifier PXD020398. Clinical data were also analyzed using SVM, alone or in combination with the proteomes. Results: A total of 2,455 proteins were identified by nano-LC-MS/MS in the samples analyzed, with 438 proteins constantly detected in all samples. SVM analysis of LFQ proteomic data delivered combinations of three proteins achieving a maximum of 88.3% for correct classification of the cardioembolic and atherothrombotic samples in our cohort. The coagulation factor XIII appeared in all of the SVM protein trios, associating with cardioembolic thrombi. A combined SVM analysis of the LFQ proteome and clinical data did not deliver a better discriminatory score as compared to the proteome only. Conclusion: Our results advance the portrayal of the human cerebrovascular thrombi proteome. The exploratory SVM analysis outlined sets of proteins for a proof-of-principle characterization of our cohort cardioembolic and atherothrombotic samples. The integrated analysis proposed herein could be further developed and retested on a larger patients population to better understand stroke origin and the associated cerebrovascular pathophysiology.
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Affiliation(s)
- Cyril Dargazanli
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France.,Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Emma Zub
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France
| | - Jeremy Deverdun
- I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, Montpellier, France
| | - Mathilde Decourcelle
- BioCampus Montpellier, CNRS, INSERM, Université de Montpellier, Montpellier, France
| | - Frédéric de Bock
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France
| | - Julien Labreuche
- Santé Publique: Epidémiologie et Qualité des Soins, CHU Lille, University of Lille, Lille, France
| | - Pierre-Henri Lefèvre
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Grégory Gascou
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Imad Derraz
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Carlos Riquelme Bareiro
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Federico Cagnazzo
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Alain Bonafé
- Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Philippe Marin
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France
| | - Vincent Costalat
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France.,Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France
| | - Nicola Marchi
- Institut de Génomique Fonctionnelle, Univ. Montpellier, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France
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18
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Di Meglio L, Desilles JP, Solonomenjanahary M, Labreuche J, Ollivier V, Dupont S, Deschildre C, Maacha MB, Consoli A, Lapergue B, Piotin M, Blanc R, Ho-Tin-Noe B, Mazighi M. DNA Content in Ischemic Stroke Thrombi Can Help Identify Cardioembolic Strokes Among Strokes of Undetermined Cause. Stroke 2020; 51:2810-2816. [PMID: 32811390 DOI: 10.1161/strokeaha.120.029134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Identification of acute ischemic stroke (AIS) cause is crucial for guidance of secondary prevention. Previous studies have yielded inconsistent results regarding possible correlations between AIS cause and thrombus composition, as assessed by semiquantitative histological analysis. Here, we performed a correlation analysis between AIS cause and AIS thrombus cellular composition and content, as assessed using quantitative biochemical assays. METHODS Homogenates of 250 patients with AIS thrombi were prepared by mechanical grinding. Platelet, red blood cell, and leukocyte content of AIS thrombi were estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. AIS cause was defined as cardioembolic, noncardioembolic, or embolic stroke of undetermined source, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment). RESULTS Cardioembolic thrombi were richer in DNA (35.8 versus 13.8 ng/mg, P<0.001) and poorer in GPVI (0.104 versus 0.117 ng/mg, P=0.045) than noncardioembolic ones. The area under the receiver operating characteristic curve of DNA content to discriminate cardioembolic thrombi from noncardioembolic was 0.72 (95% CI, 0.63-0.81). With a threshold of 44.7 ng DNA/mg thrombus, 47% of thrombi from undetermined cause would be classified as cardioembolic with a specificity of 90%. CONCLUSIONS Thrombus DNA content may provide an accurate biomarker for identification of cardioembolic thrombi in patients with AIS with embolic stroke of undetermined source. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03268668.
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Affiliation(s)
- Lucas Di Meglio
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.).,Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
| | - Jean-Philippe Desilles
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.).,Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
| | - Mialitiana Solonomenjanahary
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, France (J.L.)
| | - Véronique Ollivier
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Sebastien Dupont
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Catherine Deschildre
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Malek Ben Maacha
- Department of Clinical Research, Rothschild Foundation Hospital, Paris, France (M.B.M.)
| | - Arturo Consoli
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France (A.C., B.L.)
| | - Bertrand Lapergue
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France (A.C., B.L.)
| | - Michel Piotin
- Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
| | - Raphael Blanc
- Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
| | - Benoit Ho-Tin-Noe
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.)
| | - Mikael Mazighi
- Univ de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (L.D.M., J.-P.D., M.S., V.O., S.D., C.D., B.H.-T.-N., M.M.).,Department of Interventional Neuroradiology Rothschild Foundation Hospital, Paris, France (L.D.M., J.-P.D., M.P., R.B., M.M.)
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19
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Okada NOY, Noda K, Tanikawa R. Microsurgical embolectomy with superficial temporal artery-middle cerebral artery bypass for acute internal carotid artery dissection: A technical case report. Surg Neurol Int 2020; 11:223. [PMID: 32874726 PMCID: PMC7451183 DOI: 10.25259/sni_300_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/10/2020] [Indexed: 11/04/2022] Open
Abstract
Background:
Dissection of the internal carotid artery (ICA) is an important cause of stroke. Intravenous alteplase administration and mechanical thrombectomy have been strongly recommended for selected patients with acute ischemic stroke. However, the efficacy and safety of these treatments for ischemic stroke due to ICA dissection remain unclear. Here, we report a case of acute ICA dissection successfully treated by microsurgical embolectomy.
Case Description:
A 40-year-old man presented with sudden left hemiparesis and in an unconscious state, with a National Institutes of Health Stroke Scale score of 14. Preoperative radiologic findings revealed an ICA dissection from the extracranial ICA to the intracranial ICA and occlusion at the superior-most aspect of the ICA. A dissection at the superior-most aspect of the ICA occlusion could not be confirmed; therefore, a surgical embolectomy with bypass was initiated. It became apparent that the superior ICA occlusion was not due to dissection but rather to an embolic occlusion; therefore, we undertook a surgical embolectomy and cervical ICA ligation with a double superficial temporal artery-middle cerebral artery bypass. The postoperative course was uneventful and, at the 6-month follow-up, the Modified Rankin Scale score for this patient was 1.
Conclusion:
Surgical embolectomy with or without bypass can safely treat acute ischemic stroke due to an ICA dissection that cannot be distinguished between a dissecting occlusion and an embolic occlusion. Thus, it may be considered as an alternative option for patients in whom mechanical thrombectomy has failed or for those who are ineligible for mechanical thrombectomy.
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20
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Abstract
The structure of stroke thrombi has gained an increasing amount of interest in recent years. The advent of endovascular thrombectomy has offered the unique opportunity to provide and analyze thrombi removed from ischemic stroke patients. It has become clear that the composition of ischemic stroke thrombi is relatively heterogenous and various molecular and cellular patterns become apparent. Good understanding of the histopathologic characteristics of thrombi is important to lead future advancements in acute ischemic stroke treatment. In this review, we give a brief overview of the main stroke thrombus components that have been recently characterized in this rapidly evolving field. We also summarize how thrombus heterogeneity can affect stroke treatment.
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Affiliation(s)
- Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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21
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Heo JH, Nam HS, Kim YD, Choi JK, Kim BM, Kim DJ, Kwon I. Pathophysiologic and Therapeutic Perspectives Based on Thrombus Histology in Stroke. J Stroke 2020; 22:64-75. [PMID: 32027792 PMCID: PMC7005358 DOI: 10.5853/jos.2019.03440] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/23/2020] [Indexed: 01/04/2023] Open
Abstract
Recent advances in endovascular thrombectomy have enabled the histopathologic analysis of fresh thrombi in patients with acute stroke. Histologic analysis has shown that the thrombus composition is very heterogeneous between patients. However, the distribution pattern of each thrombus component often differs between patients with cardiac thrombi and those with arterial thrombi, and the efficacy of endovascular thrombectomy is different according to the thrombus composition. Furthermore, the thrombus age is related to the efficacy of reperfusion therapy. Recent studies have shown that neutrophils and neutrophil extracellular traps contribute to thrombus formation and resistance to reperfusion therapy. Histologic features of thrombi in patients with stroke may provide some clues to stroke etiology, which is helpful for determining the strategy of stroke prevention. Research on thrombus may also be helpful for improving reperfusion therapy, including the development of new thrombolytic agents.
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Affiliation(s)
- Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kyo Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Moon Kim
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea.,Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Il Kwon
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
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22
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Imaging Clot Characteristics in Stroke and its Possible Implication on Treatment. Clin Neuroradiol 2019; 30:27-35. [DOI: 10.1007/s00062-019-00841-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
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23
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Bacigaluppi M, Semerano A, Gullotta GS, Strambo D. Insights from thrombi retrieved in stroke due to large vessel occlusion. J Cereb Blood Flow Metab 2019; 39:1433-1451. [PMID: 31213164 PMCID: PMC6681524 DOI: 10.1177/0271678x19856131] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The recent advances of endovascular procedures to treat stroke due to large cerebral vessel occlusion have made it possible to analyze the retrieved thrombus material. Analysis of cerebral thrombi is emerging as a relevant opportunity to complement the diagnostic workup of etiology, to develop new lytic approaches and to optimize the acute treatment of stroke due to large vessel occlusion. Nonetheless, retrieved thrombi are frequently discarded since their informative potential is often neglected and standards are missing. This review provides an overview of the current knowledge and expanding research relating to thrombus composition analysis in large vessel occlusions. We first discuss the heterogeneity of thrombogenic factors that underlie the thrombotic formation in stroke and its implications to identify stroke etiology and thrombus age. Further, we show that understanding structural characteristics of thrombus is pivotal for the development of new-targeted lytic therapies as well as to improve, through thrombus modeling, the development of thrombectomy devices. Finally, we discuss the on-going attempts to identify a signature of thrombus composition indirectly through imaging and peripheral blood biomarkers, which might in future assist treatment decision-making as well as secondary prevention. Thrombus analysis might contribute to the advancement and optimization of personalized stroke treatments.
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Affiliation(s)
- Marco Bacigaluppi
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Aurora Semerano
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Giorgia Serena Gullotta
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Davide Strambo
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy.,2 Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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24
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Fitzgerald S, Mereuta OM, Doyle KM, Dai D, Kadirvel R, Kallmes DF, Brinjikji W. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome. J Neurosurg Sci 2019; 63:292-300. [PMID: 30514073 PMCID: PMC8693286 DOI: 10.23736/s0390-5616.18.04629-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mechanical thrombectomy has become the stand of care for patients with large vessel occlusions, yet major improvements in thrombectomy speed, efficacy, and completeness can still be achieved. High rates of clot fragmentation and failure to remove the clot resulting in poor neurological outcomes suggest that in order to further advance the field of stroke intervention we must turn our attention towards understanding the science of clot. Accurately identifying the composition of the occlusive clot prior to intervention could significantly influence the success of the revascularization strategy used to treat them. Numerous features of thromboemboli could be studied and characterized, including quantitative histomorphometry and diagnostic imaging characteristics. Each of these features might logically predict superior thrombectomy outcomes with one device or another. This article aims to review the current literature on histopathological composition of acute ischemic stroke clots, with a particular focus on the correlation between clot composition and diagnostic imaging, stroke etiology and revascularization outcomes.
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Affiliation(s)
- Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Oana M Mereuta
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Karen M Doyle
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA -
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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25
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Abstract
Cerebral ischemic stroke treatment may change significantly now that clots are actually physically removed from the patient using thrombectomy. This allows for an analysis of the content of the clots as well as the correlation of the imaging findings and the clot behavior and morphology. This article illustrates how the interaction of different clots varies in the clinical setting and how analysis of clot composition, as well as the search for new pharmacologic targets, can lead to a better understanding of the pathophysiology and therapy resistance, in turn providing possibilities for a better approach in the treatment.
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Affiliation(s)
- Patrick A. Brouwer
- Neuroradiology Department, Neurointervention section, Karolinska University Hospital Stockholm, Sweden
| | - Waleed Brinjikji
- Departments of Radiology and Neurosurgery, Mayo Clinic Rochester MN, USA
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto ON, Canada
| | - Simon F. De Meyer
- Laboratory for Thrombosis Research, KU Leuven, Campus Kulak Kortrijk, Kortrijk, Belgium
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26
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Fraser JF, Collier LA, Gorman AA, Martha SR, Salmeron KE, Trout AL, Edwards DN, Davis SM, Lukins DE, Alhajeri A, Grupke S, Roberts JM, Bix GJ, Pennypacker KR. The Blood And Clot Thrombectomy Registry And Collaboration (BACTRAC) protocol: novel method for evaluating human stroke. J Neurointerv Surg 2018; 11:265-270. [PMID: 30064997 DOI: 10.1136/neurintsurg-2018-014118] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ischemic stroke research faces difficulties in translating pathology between animal models and human patients to develop treatments. Mechanical thrombectomy, for the first time, offers a momentary window into the changes occurring in ischemia. We developed a tissue banking protocol to capture intracranial thrombi and the blood immediately proximal and distal to it. OBJECTIVE To develop and share a reproducible protocol to bank these specimens for future analysis. METHODS We established a protocol approved by the institutional review board for tissue processing during thrombectomy (www.clinicaltrials.gov NCT03153683). The protocol was a joint clinical/basic science effort among multiple laboratories and the NeuroInterventional Radiology service line. We constructed a workspace in the angiography suite, and developed a step-by-step process for specimen retrieval and processing. RESULTS Our protocol successfully yielded samples for analysis in all but one case. In our preliminary dataset, the process produced adequate amounts of tissue from distal blood, proximal blood, and thrombi for gene expression and proteomics analyses. We describe the tissue banking protocol, and highlight training protocols and mechanics of on-call research staffing. In addition, preliminary integrity analyses demonstrated high-quality yields for RNA and protein. CONCLUSIONS We have developed a novel tissue banking protocol using mechanical thrombectomy to capture thrombus along with arterial blood proximal and distal to it. The protocol provides high-quality specimens, facilitating analysis of the initial molecular response to ischemic stroke in the human condition for the first time. This approach will permit reverse translation to animal models for treatment development.
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Affiliation(s)
- Justin F Fraser
- Departments of Neuroscience, University of Kentucky, Lexington, Kentucky, USA.,Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Lisa A Collier
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Amy A Gorman
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - Sarah R Martha
- Departments of Neuroscience, University of Kentucky, Lexington, Kentucky, USA.,College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Kathleen E Salmeron
- Departments of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Amanda L Trout
- Departments of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Danielle N Edwards
- Departments of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Stephanie M Davis
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Douglas E Lukins
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Abdulnasser Alhajeri
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA.,Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - Stephen Grupke
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA.,Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - Jill M Roberts
- Departments of Neuroscience, University of Kentucky, Lexington, Kentucky, USA.,Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - Gregory J Bix
- Departments of Neuroscience, University of Kentucky, Lexington, Kentucky, USA.,Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.,Department of Neurological Surgery, University of Kentucky, Lexington, KY
| | - Keith R Pennypacker
- Departments of Neuroscience, University of Kentucky, Lexington, Kentucky, USA.,Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
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27
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Muñoz R, Santamaría E, Rubio I, Ausín K, Ostolaza A, Labarga A, Roldán M, Zandio B, Mayor S, Bermejo R, Mendigaña M, Herrera M, Aymerich N, Olier J, Gállego J, Mendioroz M, Fernández-Irigoyen J. Mass Spectrometry-Based Proteomic Profiling of Thrombotic Material Obtained by Endovascular Thrombectomy in Patients with Ischemic Stroke. Int J Mol Sci 2018; 19:ijms19020498. [PMID: 29414888 PMCID: PMC5855720 DOI: 10.3390/ijms19020498] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 12/25/2022] Open
Abstract
Thrombotic material retrieved from acute ischemic stroke (AIS) patients represents a valuable source of biological information. In this study, we have developed a clinical proteomics workflow to characterize the protein cargo of thrombi derived from AIS patients. To analyze the thrombus proteome in a large-scale format, we developed a workflow that combines the isolation of thrombus by endovascular thrombectomy and peptide chromatographic fractionation coupled to mass-spectrometry. Using this workflow, we have characterized a specific proteomic expression profile derived from four AIS patients included in this study. Around 1600 protein species were unambiguously identified in the analyzed material. Functional bioinformatics analyses were performed, emphasizing a clustering of proteins with immunological functions as well as cardiopathy-related proteins with blood-cell dependent functions and peripheral vascular processes. In addition, we established a reference proteomic fingerprint of 341 proteins commonly detected in all patients. Protein interactome network of this subproteome revealed protein clusters involved in the interaction of fibronectin with 14-3-3 proteins, TGFβ signaling, and TCP complex network. Taken together, our data contributes to the repertoire of the human thrombus proteome, serving as a reference library to increase our knowledge about the molecular basis of thrombus derived from AIS patients, paving the way toward the establishment of a quantitative approach necessary to detect and characterize potential novel biomarkers in the stroke field.
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Affiliation(s)
- Roberto Muñoz
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Enrique Santamaría
- Clinical Neuroproteomics Laboratory, Navarrabiomed, Departamento de Salud, Universidad Pública de Navarra, IDISNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
- Proteored-ISCIII, Proteomics Unit, Navarrabiomed, Departamento de Salud, Universidad Pública de Navarra, IDISNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
| | - Idoya Rubio
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Karina Ausín
- Proteored-ISCIII, Proteomics Unit, Navarrabiomed, Departamento de Salud, Universidad Pública de Navarra, IDISNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
| | - Aiora Ostolaza
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Alberto Labarga
- Bioinformatics Laboratory, Navarrabiomed-Departamento de Salud, Universidad Pública de Navarra, IDISNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
| | - Miren Roldán
- Neuroepigenetics Laboratory, Navarrabiomed-Departamento de Salud, Universidad Pública de Navarra, IDISNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
| | - Beatriz Zandio
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Sergio Mayor
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Rebeca Bermejo
- Department of Interventional Neuroradiology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Mónica Mendigaña
- Department of Interventional Neuroradiology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - María Herrera
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Nuria Aymerich
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Jorge Olier
- Department of Interventional Neuroradiology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Jaime Gállego
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | - Maite Mendioroz
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
- Neuroepigenetics Laboratory, Navarrabiomed-Departamento de Salud, Universidad Pública de Navarra, IDISNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
| | - Joaquín Fernández-Irigoyen
- Clinical Neuroproteomics Laboratory, Navarrabiomed, Departamento de Salud, Universidad Pública de Navarra, IDISNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
- Proteored-ISCIII, Proteomics Unit, Navarrabiomed, Departamento de Salud, Universidad Pública de Navarra, IDISNA, Navarra Institute for Health Research, Pamplona 31008, Spain.
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28
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Baek BH, Kim HS, Yoon W, Lee YY, Baek JM, Kim EH, Kim SK. Inflammatory mediator expression within retrieved clots in acute ischemic stroke. Ann Clin Transl Neurol 2018; 5:273-279. [PMID: 29560373 PMCID: PMC5846392 DOI: 10.1002/acn3.529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022] Open
Abstract
Objective In this study we investigate the association between the expression of inflammatory mediators measured in clots retrieved by mechanical thrombectomy, stroke etiology, and the susceptibility vessel sign (SVS) on gradient-echo (GRE) MR imaging in acute ischemic stroke patients. Methods We performed molecular analysis of intracranial clots retrieved by mechanical thrombectomy from 82 patients with acute stroke. Seventy-two of these patients underwent GRE imaging before endovascular therapy. We measured the relative expression of inflammatory mediators by performing the quantitative real-time polymerase chain reaction on the retrieved clots and assessed associations between the expression of inflammatory mediators and stroke subtypes as well as with GRE SVS. Results Classifications of stroke etiology for the cohort were as follows: cardioembolism (51, 62.2%), large artery atherosclerosis (9, 11%), and undetermined etiology (22, 26.8%). Clots associated with large artery atherosclerosis showed significantly higher interleukin (IL)-1β expression than clots from both cardioembolism and undetermined etiology (P = 0.008). A positive SVS was identified in 48 of 72 patients (66.7%) who had GRE imaging. IL-1β, tumor necrosis factor-α, and matrix metalloproteinase-9 expressions were significantly higher in clots with a negative SVS than in those with a positive SVS (P = 0.010, 0.049, and 0.004, respectively). Interpretation Expression of inflammatory mediators in intracranial clots differs significantly based on stroke etiology or presence or the absence of SVS on GRE imaging. This study suggests that molecular analysis of inflammatory mediators in retrieved clots is a promising tool for determining stroke mechanism in acute ischemic stroke patients.
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Affiliation(s)
- Byung Hyun Baek
- Department of Radiology Chonnam National University Medical School Chonnam National University Hospital Gwangju Korea
| | - Hyung Seok Kim
- Department of Forensic Medicine Chonnam National University Medical School Chonnam National University Hospital Gwangju Korea
| | - Woong Yoon
- Department of Radiology Chonnam National University Medical School Chonnam National University Hospital Gwangju Korea
| | - Yun Young Lee
- Department of Radiology Chonnam National University Medical School Chonnam National University Hospital Gwangju Korea
| | - Jang Mi Baek
- Department of Radiology Chonnam National University Medical School Chonnam National University Hospital Gwangju Korea
| | - Eun Hee Kim
- Department of Forensic Medicine Chonnam National University Medical School Chonnam National University Hospital Gwangju Korea
| | - Seul Kee Kim
- Department of Radiology Chonnam National University Medical School Chonnam National University Hospital Gwangju Korea
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29
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Gounis MJ, Chapot R. Histological Composition and the Origin of the Thrombus: A New Diagnostic Assay for Secondary Stroke Prevention? Stroke 2017. [PMID: 28626053 DOI: 10.1161/strokeaha.117.017630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew J Gounis
- From the Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester (M.J.G.); and Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (R.C.).
| | - René Chapot
- From the Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester (M.J.G.); and Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany (R.C.)
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30
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Sporns PB, Hanning U, Schwindt W, Velasco A, Minnerup J, Zoubi T, Heindel W, Jeibmann A, Niederstadt TU. Ischemic Stroke: What Does the Histological Composition Tell Us About the Origin of the Thrombus? Stroke 2017. [PMID: 28626055 DOI: 10.1161/strokeaha.117.016590] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE The introduction of stent retrievers allows for a complete extraction and histological analysis of human thrombi. Ischemic stroke is a major health issue, and differentiation of underlying causes is highly relevant to prevent recurrent stroke. Therefore, histopathologic analysis of the embolic clots after removal may provide valuable information about underlying pathologies. This study analyzes histological clot composition and aims to identify specific patterns that might help to distinguish causes of ischemic stroke. METHODS Patients with occlusion of the carotid-T or middle cerebral artery who underwent thrombectomy at our university medical center between December 2013 and February 2016 were included. Samples were histologically analyzed (hematoxylin and eosin, Elastica van Gieson, and Prussian blue), additionally immunohistochemistry for CD3, CD20, and CD68/KiM1P was performed. These data, along with additional clinical and interventional parameters, were compared for different stroke subtypes, as defined by the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. RESULTS One hundred eighty-seven patients were included, of these, in 77 patients, cardioembolic; in 46 patients, noncardioembolic; and in 64 patients, cryptogenic pathogenesis was determined. Cardioembolic thrombi had higher proportions of fibrin/platelets (P=0.027), less erythrocytes (P=0.005), and more leucocytes (P=0.026) than noncardioembolic thrombi. We observed a strong overlap of cryptogenic strokes and cardioembolic strokes concerning thrombus histology. The immunohistochemical parameters CD3, CD20, and CD68/KiM1P showed no statistically noticeable differences between stroke subtypes. CONCLUSIONS Histological thrombus features vary significantly according to the underlying cause and may help to differentiate between cardioembolic and noncardioembolic stroke. In addition, our study supports the hypothesis that most cryptogenic strokes have a cardioembolic cause.
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Affiliation(s)
- Peter B Sporns
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.).
| | - Uta Hanning
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.)
| | - Wolfram Schwindt
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.)
| | - Aglaé Velasco
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.)
| | - Jens Minnerup
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.)
| | - Tarek Zoubi
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.)
| | - Walter Heindel
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.)
| | - Astrid Jeibmann
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.)
| | - Thomas Ulrich Niederstadt
- From the Department of Clinical Radiology (P.B.S., U.H., W.S., A.V., T.Z., W.H., T.N.), Department of Neurology (J.M.), and Institute of Neuropathology (A.J.), University Hospital Muenster, Germany; and Institute of Epidemiology and Social Medicine, University of Muenster, Germany (U.H.)
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31
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Brinjikji W, Duffy S, Burrows A, Hacke W, Liebeskind D, Majoie CBLM, Dippel DWJ, Siddiqui AH, Khatri P, Baxter B, Nogeuira R, Gounis M, Jovin T, Kallmes DF. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review. J Neurointerv Surg 2017; 9:529-534. [PMID: 27166383 PMCID: PMC6697418 DOI: 10.1136/neurintsurg-2016-012391] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/15/2016] [Accepted: 04/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Studying the imaging and histopathologic characteristics of thrombi in ischemic stroke could provide insights into stroke etiology and ideal treatment strategies. We conducted a systematic review of imaging and histologic characteristics of thrombi in acute ischemic stroke. MATERIALS AND METHODS We identified all studies published between January 2005 and December 2015 that reported findings related to histologic and/or imaging characteristics of thrombi in acute ischemic stroke secondary to large vessel occlusion. The five outcomes examined in this study were (1) association between histologic composition of thrombi and stroke etiology; (2) association between histologic composition of thrombi and angiographic outcomes; (3) association between thrombi imaging and histologic characteristics; (4) association between thrombi imaging characteristics and angiographic outcomes; and (5) association between imaging characteristics of thrombi and stroke etiology. A meta-analysis was performed using a random effects model. RESULTS There was no significant difference in the proportion of red blood cell (RBC)-rich thrombi between cardioembolic and large artery atherosclerosis etiologies (OR 1.62, 95% CI 0.1 to 28.0, p=0.63). Patients with a hyperdense artery sign had a higher odds of having RBC-rich thrombi than those without a hyperdense artery sign (OR 9.0, 95% CI 2.6 to 31.2, p<0.01). Patients with a good angiographic outcome had a mean thrombus Hounsfield unit (HU) of 55.1±3.1 compared with a mean HU of 48.4±1.9 for patients with a poor angiographic outcome (mean standard difference 6.5, 95% CI 2.7 to 10.2, p<0.001). There was no association between imaging characteristics and stroke etiology (OR 1.13, 95% CI 0.32 to 4.00, p=0.85). CONCLUSIONS The hyperdense artery sign is associated with RBC-rich thrombi and improved recanalization rates. However, there was no association between the histopathological characteristics of thrombi and stroke etiology and angiographic outcomes.
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Affiliation(s)
| | - Sharon Duffy
- Department of Engineering, Galway-Mayo Institute of Technology, Galway, Ireland
| | - Anthony Burrows
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - David Liebeskind
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Charles B L M Majoie
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Adnan H Siddiqui
- Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA
| | - Pooja Khatri
- Department of Neurology, University of Cincinatti, Cincinatti, Ohio, USA
| | - Blaise Baxter
- Department of Radiology, University of Tennessee Medical Center, Chatanooga, Tennessee, USA
| | - Raul Nogeuira
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Matt Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Tudor Jovin
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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32
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De Meyer SF, Andersson T, Baxter B, Bendszus M, Brouwer P, Brinjikji W, Campbell BC, Costalat V, Dávalos A, Demchuk A, Dippel D, Fiehler J, Fischer U, Gilvarry M, Gounis MJ, Gralla J, Jansen O, Jovin T, Kallmes D, Khatri P, Lees KR, López-Cancio E, Majoie C, Marquering H, Narata AP, Nogueira R, Ringleb P, Siddiqui A, Szikora I, Vale D, von Kummer R, Yoo AJ, Hacke W, Liebeskind DS. Analyses of thrombi in acute ischemic stroke: A consensus statement on current knowledge and future directions. Int J Stroke 2017; 12:606-614. [PMID: 28534706 DOI: 10.1177/1747493017709671] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention. Current imaging techniques can provide some information about thrombi, but there remains much to evaluate about relationships that may exist among thrombus composition, occlusion characteristics and treatment outcomes. Improved pathophysiological characterization of clot types, their properties and how these properties change over time, together with clinical correlates from ongoing studies, may facilitate revascularization with thrombolysis and thrombectomy. Interdisciplinary approaches covering clinical, engineering and scientific aspects of thrombus research will be key to advancing the understanding of thrombi and improving acute ischemic stroke therapy. This consensus statement integrates recent research on clots and thrombi retrieved from cerebral arteries and provides a rationale for further analyses, including current opportunities and limitations.
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Affiliation(s)
- Simon F De Meyer
- 1 Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Tommy Andersson
- 2 Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,3 Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,4 Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Blaise Baxter
- 5 Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga
| | - Martin Bendszus
- 6 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Patrick Brouwer
- 3 Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Waleed Brinjikji
- 7 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce Cv Campbell
- 8 Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Vincent Costalat
- 9 Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Antoni Dávalos
- 10 Acute Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Andrew Demchuk
- 11 Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Canada
| | - Diederik Dippel
- 12 Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jens Fiehler
- 13 Department of Neuroradiology, University Medical Center, Hamburg, Germany
| | - Urs Fischer
- 14 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Gilvarry
- 15 Neuravi Thromboembolic Initiative, Neuravi Ltd, Galway, Ireland
| | - Matthew J Gounis
- 16 Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jan Gralla
- 17 Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olav Jansen
- 18 Department of Radiology and Neuroradiology, UKSH, Kiel, Germany
| | - Tudor Jovin
- 19 Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David Kallmes
- 7 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pooja Khatri
- 20 Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kennedy R Lees
- 21 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK
| | - Elena López-Cancio
- 10 Acute Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Charles Majoie
- 22 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Henk Marquering
- 22 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.,23 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Raul Nogueira
- 25 Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Peter Ringleb
- 26 Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Adnan Siddiqui
- 27 Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA
| | - István Szikora
- 28 Department of Neuroradiology, National Institute of Neurosciences, Budapest, Hungary
| | - David Vale
- 15 Neuravi Thromboembolic Initiative, Neuravi Ltd, Galway, Ireland
| | | | | | - Werner Hacke
- 31 Department of Neurology, University Hospital Heidelberg, Ruprecht-Karls University, Heidelberg, Germany
| | - David S Liebeskind
- 32 Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, California, USA
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Bourcier R, Brecheteau N, Costalat V, Daumas-Duport B, Guyomarch-Delasalle B, Desal H, Naggara O, Serfaty JM. MRI quantitative T2* mapping on thrombus to predict recanalization after endovascular treatment for acute anterior ischemic stroke. J Neuroradiol 2017; 44:241-246. [PMID: 28478114 DOI: 10.1016/j.neurad.2017.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/13/2017] [Accepted: 03/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND In anterior acute ischemic stroke (AAIS) treated with endovascular treatment (EVT), the susceptibility vessel sign (SVS+ or SVS-) is related to recanalization results (TICI 2b/3) and clinical outcome. However, a binary qualitative assessment of thrombus using SVS does not reflect its complex composition. Our aim was to assess whether a quantitative MRI marker, Thrombus-T2* relaxation time, may be assessable in clinical routine and may to predict early successful recanalization after EVT, defined as a TICI 2b/3 recanalization obtained in 2 attempts or less. MATERIAL AND METHODS Thrombus-T2* relaxation time was prospectively obtained from consecutive AAIS patients treated by EVT (concomitant aspiration and stent retriever). Quantitative values were compared between early recanalization and late or unsuccessful recanalization. RESULTS Thirty patients with AAIS were included and Thrombus-T2* relaxation time was obtained in all patients. Earlier TICI 2b/3 recanalization were obtained in 22 patients (73%) and was significantly associated with SVS+ (1/8 vs. 16/22, P=0.01) and a shorter Thombus-T2* relaxation time (mean SD, range: 257, 18-50ms vs. 45 9, 35-60ms, P<0.001). CONCLUSION A new quantitative MRI biomarker, the Thrombus-T2* relaxation time is assessable in clinical routine. In a preliminary study of 30 patients, a shorter Thombus-T2* relaxation time is related to earlier recanalization after EVT using combination of stent retriever and aspiration.
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Affiliation(s)
- R Bourcier
- Departments of Diagnostic and Interventional Neuroradiology of the University Hospital of Nantes, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France; Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France
| | - N Brecheteau
- Departments of Diagnostic and Interventional Neuroradiology of the University Hospital of Nantes, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France; Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France.
| | - V Costalat
- Department of Neuroradiology, Centre Hospitalier Universitaire, Montpellier, France
| | - B Daumas-Duport
- Departments of Diagnostic and Interventional Neuroradiology of the University Hospital of Nantes, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France; Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France
| | - B Guyomarch-Delasalle
- Centre Hospitalier Universitaire Nantes Hôpital G et R Laënnec, Nantes, France; Centre d'investigation clinique Thorax, l'institut du thorax, Nantes, France; Centre national de la recherche scientifique, 75016 Paris, France
| | - H Desal
- Departments of Diagnostic and Interventional Neuroradiology of the University Hospital of Nantes, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France; Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France
| | - O Naggara
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, France
| | - J M Serfaty
- Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France; Departments of Diagnostic Cardiac and Vascular Imaging, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France
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Boeckh-Behrens T, Kleine J, Kaesmacher J, Zimmer C, Schirmer L, Simon S, Poppert H. The CD31 molecule: a possible neuroprotective agent in acute ischemic stroke? Thromb J 2017; 15:11. [PMID: 28413360 PMCID: PMC5390341 DOI: 10.1186/s12959-017-0134-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/08/2017] [Indexed: 01/01/2023] Open
Abstract
Background The transmembrane receptor molecule CD31 is known to have immunomodulatory functions, suggesting a possible neuroprotective effect in the context of acute ischemic stroke by restricting an over-activation of secondary immunological processes. This study examines the density of CD31+ cells in mechanically extracted thrombi of stroke patients with the aim to test whether the occurrence of CD31+ cells was associated with a beneficial clinical outcome in those patients. Methods Thrombi of 122 consecutive patients with large anterior circulation stroke were collected during intracranial mechanical recanalization. Out of these, 86 immunostained specimens of adequate quality could be analysed. The density of CD31+ cells was quantified and compared with clinical outcome data of the affected patients. Results The density of CD31+ cells was positively related to early patient improvement (ΔNIHSS, r = 0.283, p = 0,012) with an even clearer relationship after exclusion of patients who died in the early hospital phase (r = 0.371, p = 0.001). This finding stayed stable also in the multivariate analysis after corrrection for other outcome-influencing factors (p = 0.049). Conclusion This study shows a stable relation between CD31+ cells and early clinical improvement of patients with acute ischemic stroke. This finding is in line with recent reports showing immunomodulatory and potential neuroprotective effects of CD31, suggesting that CD31 may be a promising neuroprotective agent in stroke patients.
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Affiliation(s)
- Tobias Boeckh-Behrens
- Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Justus Kleine
- Department of Neuroradiology, Vivantes Klinikum Neukölln, Rudowerstr. 48, 12351 Berlin, Germany
| | - Johannes Kaesmacher
- Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lucas Schirmer
- Department of Neurology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sophie Simon
- Department of Neurology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Holger Poppert
- Department of Neurology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Dargazanli C, Consoli A, Barral M, Labreuche J, Redjem H, Ciccio G, Smajda S, Desilles JP, Taylor G, Preda C, Coskun O, Rodesch G, Piotin M, Blanc R, Lapergue B. Impact of Modified TICI 3 versus Modified TICI 2b Reperfusion Score to Predict Good Outcome following Endovascular Therapy. AJNR Am J Neuroradiol 2016; 38:90-96. [PMID: 27811134 DOI: 10.3174/ajnr.a4968] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The TICI score is widely used to evaluate cerebral perfusion before and after the endovascular treatment of stroke. Recent studies showing the effectiveness and safety of mechanical thrombectomy combine modified TICI 2b and modified TICI 3 to assess the technical success of endovascular treatment. The purpose of this study was to determine how much clinical outcomes differ between patients achieving modified TICI 2b and modified TICI 3 reperfusion. MATERIALS AND METHODS We analyzed 222 consecutive patients with acute large intracranial artery occlusion of the anterior circulation having achieved modified TICI 2b or modified TICI 3 reperfusion after thrombectomy. The primary end point was the rate of favorable outcome defined as the achievement of a modified Rankin Scale score of 0-2 at 3 months. RESULTS Patients with modified TICI 3 more often had favorable collateral circulation and atherosclerosis etiology, with a shorter time from onset to reperfusion than patients with modified TICI 2b (all P < .05). The number of total passes to achieve reperfusion was higher in the modified TICI 2b group (median, 2; interquartile range, 1-3, 1-9) versus (median, 1; interquartile range, 1-2, 1-8) in the modified TICI 3 group (P = .0002). Favorable outcome was reached more often for patients with modified TICI 3 than for those with modified TICI 2b (71.7% versus 50.5%, P = .001), with a similar difference when considering excellent outcome. In addition, patients with modified TICI 3 had a lower intracerebral hemorrhage rate (23.0% versus 45.0%, P < .001). CONCLUSIONS Patients with modified TICI 3 reperfusion have better functional outcomes than those with modified TICI 2b. Given the improving reperfusion rates obtained with thrombectomy devices, future thrombectomy trials should consider modified TICI 2b and modified TICI 3 status separately.
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Affiliation(s)
- C Dargazanli
- From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.)
| | - A Consoli
- Department of Diagnostic and Interventional Neuroradiology (A.C., O.C., G.R.)
| | - M Barral
- From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.)
| | - J Labreuche
- Department of Biostatistics (J.L.), University of Lille, Epidémiologie et Qualité des Soins, Lille, France
| | - H Redjem
- From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.)
| | - G Ciccio
- From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.)
| | - S Smajda
- From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.)
| | - J P Desilles
- From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.)
| | - G Taylor
- Anesthesiology and Reanimation (G.T.), Rothschild Foundation, Paris, France
| | - C Preda
- Laboratoire de Mathématiques Paul Painlevé (C.P.), Lille, France
| | - O Coskun
- Department of Diagnostic and Interventional Neuroradiology (A.C., O.C., G.R.)
| | - G Rodesch
- Department of Diagnostic and Interventional Neuroradiology (A.C., O.C., G.R.)
| | - M Piotin
- From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.)
| | - R Blanc
- From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.)
| | - B Lapergue
- Division of Neurology, Stroke Center (B.L.), Foch Hospital, Université Versailles Saint Quentin en Yvelines, Suresnes, France
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