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. 2021 Sep;31(3):753-761.
doi: 10.1007/s00062-020-00964-5. Epub 2020 Oct 2.

Thrombus Histology of Basilar Artery Occlusions : Are There Differences to the Anterior Circulation?

M Berndt  1 , H Poppert  2   3 , K Steiger  4 , J Pelisek  5   6 , P Oberdieck  7 , C Maegerlein  8 , C Zimmer  8 , S Wunderlich  3 , B Friedrich  8 , T Boeckh-Behrens  8 , B Ikenberg  3
Affiliations

Thrombus Histology of Basilar Artery Occlusions : Are There Differences to the Anterior Circulation?

M Berndt et al. Clin Neuroradiol. 2021 Sep.

Abstract

Background: For patients with acute vessel occlusions of the anterior circulation histopathology of retrieved cerebral thrombi has been reported to be associated to stroke etiology. Due to the relatively small incidence of posterior circulation stroke, exclusive histopathologic analyses are missing for this subgroup. The aim of the study was to investigate thrombus histology for patients with basilar artery occlusions and uncover differences to anterior circulation clots with respect to underlying etiology.

Methods: A total of 59 basilar thrombi were collected during intracranial mechanical recanalization and quantitatively analyzed in terms of their relative fractions of the main constituents, e.g. fibrin/platelets (F/P), red (RBC) and white blood cells (WBC). Data were compared to histopathological analyses of 122 thrombi of the anterior circulation with respect to underlying pathogenesis.

Results: The composition of basilar thrombi differed significantly to thrombi of the anterior circulation with an overall higher RBC amount (median fraction in % (interquartile range):0.48 (0.37-0.69) vs. 0.37 (0.28-0.50), p < 0.001) and lower F/P count (0.45 (0.21-0.58) vs. 0.57 (0.44-0.66), p < 0.001). Basilar thrombi composition did not differ between the different etiological stroke subgroups.

Conclusion: The results depict a differing thrombus composition of basilar thrombi in comparison to anterior circulation clots with an overall higher amount of RBC. This may reflect different pathophysiologic processes between anterior and posterior circulation thrombogenesis, e.g. a larger proportion of appositional thrombus growth in the posterior circulation.

Keywords: Clot; Histology; Stroke; Thrombectomy.

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Conflict of interest statement

M. Berndt, H. Poppert, K. Steiger, J. Pelisek, P. Oberdieck, C. Maegerlein, C. Zimmer, S. Wunderlich, B. Friedrich, T. Boeckh-Behrens and B. Ikenberg declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Histopathologic morphology of two hematoxylin-eosin (HE) stained cerebral thrombi. a Thrombus retrieved from the middle cerebral artery. b thrombus from the basilar artery. Etiology of stroke of each was cardioembolic origin. Comparison of clot fractions depicts higher red blood cell count in the thrombus from posterior circulation. Both thrombi are HE-stained, depicting red blood cells (red), white blood cell aggregations (dark blue) and fibrin/platelet area (purple). Black bar 150 μm in the overview image and 50 µm in the small box
Fig. 2
Fig. 2
a–d Distributions of thrombus compositions for thrombi of the anterior circulation in comparison to basilar thrombi (a RBC, b F/P, c CR, d WBC). e–h Thrombus composition according to stroke pathogeneses for anterior and basilar thrombi (e RBC, f F/P, g CR, h WBC) according to the TOAST classification (1 large-artery atherosclerosis, 2 cardioembolic, 4 other determined etiology, 5 undetermined etiology). BAO basilar artery occlusion, RBC Red Blood Cells, WBC White Blood Cells, F/P Fibrin/Platelets, CR Composition Ratio (RBC/FP), TOAST Trial of ORG 10172 in Acute Stroke Treatment
See this image and copyright information in PMC

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