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. 2017 Jun;9(6):529-534.
doi: 10.1136/neurintsurg-2016-012391. Epub 2016 May 10.

Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review

Waleed Brinjikji  1 , Sharon Duffy  2 , Anthony Burrows  1 , Werner Hacke  3 , David Liebeskind  4 , Charles B L M Majoie  5 , Diederik W J Dippel  6 , Adnan H Siddiqui  7 , Pooja Khatri  8 , Blaise Baxter  9 , Raul Nogeuira  10 , Matt Gounis  11 , Tudor Jovin  12 , David F Kallmes  1
Affiliations

Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review

Waleed Brinjikji et al. J Neurointerv Surg. 2017 Jun.

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.

Keywords: CT; Intervention; Stroke; Thrombectomy; Thrombolysis.

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Figures

Figure 1:
Figure 1:. Commonly used histological stain in acute ischemic stroke clot assessment.
A&E are gross photographs of clots removed from two different patients that had suffered an acute ischemic stroke with an area of suspected calcification in E highlighted with a red box. B&F are examples of H&E stained slides from the corresponding clots showing Red Blood Cells (Red), White Blood Cells (Purple) and Fibrin/Platelets (Pink). C&G are examples of MSB stained slides showing Red Blood Cells (Yellow), White Blood Cells (Purple), Fibrin (Red) and Platelets/Other (Grey). D&H are examples of Masson’s Trichrome stained slide showing Red Blood Cells (Red), White Blood Cells (Purple) and Fibrin/Platelets (Purple). I is an example of a von Kossa stained slide confirming the presence of calcification (Brown).
Figure 2:
Figure 2:. Histologic and Immunohistochemical Analysis of an acute ischemic stroke clot.
(A) is a gross photograph a ‘White’ clot retrieved from a patient using a mechanical thrombectomy procedure. (B) is an example of an MSB stained slide from the same clot showing the presence of Red Blood Cells (Yellow), White Blood Cells (Purple), Fibrin (Red) and Platelets/Other (Grey). (C) is an example of an immunohistochemically stained slide demonstrating the presence of Platelets in the clot (CD42b=Red). (D) is an example of an immunohistochemically stained slide demonstrating the presence of von Willebrand factor (Red).
See this image and copyright information in PMC

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