Gorsel BV, Remmers MJM, Vos LD, Scholzel BE, Haans DAW, Aarts RAHM, Versteylen RJ, Van Norden AGW, Van Oers CAMM, Vos J, IJsselmuiden SJJ, Van Den Branden BJL, De Boer OJ, Imani F, Alings M, Pertiwi KR, De Winter RJ, Miah I, Van Der Wal AC, Van De Hoef TP, Meuwissen M. Prognostic Value of Histopathological Thrombus Age in Large Vessel Occlusion-Related Stroke.
Cerebrovasc Dis Extra 2023;
13:97-104. [PMID:
37931606 PMCID:
PMC10697748 DOI:
10.1159/000534937]
[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: 07/08/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION
Acute mechanical thrombectomy (MT) is the preferred treatment for large vessel occlusion-related stroke. Histopathological research on the obtained occlusive embolic thrombus may provide information regarding the aetiology and pathology of the lesion to predict prognosis and propose possible future acute ischaemic stroke therapy.
METHODS
A total of 75 consecutive patients who presented to the Amphia Hospital with acute large vessel occlusion-related stroke and underwent MT were included in the study. The obtained thrombus materials were subjected to standard histopathological examination. Based on histological criteria, they were considered fresh (<1 day old) or old (>1 day old). Patients were followed for 2 years for documentation of all-cause mortality.
RESULTS
Thrombi were classified as fresh in 40 patients (53%) and as older in 35 patients (47%). Univariate Cox regression analysis showed that thrombus age, National Institutes of Health Stroke Scale at hospital admission, and patient age were associated with long-term mortality (p < 0.1). Multivariable Cox hazards and Kaplan-Meier analysis demonstrated that after extensive adjustment for clinical and procedural variables, thrombus age persisted in being independently associated with higher long-term mortality (hazard ratio: 3.34; p = 0.038, log-rank p = 0.013).
CONCLUSION
In this study, older thromboemboli are responsible for almost half of acute large ischaemic strokes. Moreover, the presence of an old thrombus is an independent predictor of mortality in acute large vessel occlusion-related stroke. More research is warranted regarding future therapies based on thrombus composition.
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