Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023;13(1):97-104.
doi: 10.1159/000534937. Epub 2023 Nov 6.

Prognostic Value of Histopathological Thrombus Age in Large Vessel Occlusion-Related Stroke

Bart Van Gorsel  1 , Michel J M Remmers  1 , Louwerens D Vos  1 , Bas E Scholzel  1 , Dirk A W Haans  1 , Ruud A H M Aarts  1 , Rob J Versteylen  1 , Anouk G W Van Norden  1 , Casper A M M Van Oers  1 , Jeroen Vos  1 , Sander J J IJsselmuiden  1 , Ben J L Van Den Branden  1 , Onno J De Boer  2 , Farshad Imani  1 , Marco Alings  1 , Kartika R Pertiwi  2 , Robbert J De Winter  2 , Ishita Miah  1 , Allard C Van Der Wal  2 , Tim P Van De Hoef  3 , Martijn Meuwissen  1
Affiliations

Prognostic Value of Histopathological Thrombus Age in Large Vessel Occlusion-Related Stroke

Bart Van Gorsel et al. Cerebrovasc Dis Extra. 2023.

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.

Keywords: Prognosis; Stroke; Thrombectomy; Thrombus.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Example of histological appearance of fresh thrombus. Layered patterns of platelets, fibrin, erythrocytes, and intact granulocytes (H&E stain). *Erythrocytes, **thrombocytes, and ***granulocytes.
Fig. 2.
Fig. 2.
Example of the histology of an old thrombus, showing extensive necrosis and organization by myofibrocellular ingrowth and depositions of connective tissue (H&E stain). *Area of colliquation necrosis, **area of fibrocellular organization.
Fig. 3.
Fig. 3.
Kaplan-Meier estimates of mortality for fresh versus old thrombi in LVOS patients.
See this image and copyright information in PMC

References

    1. Rai AT, Link PS, Domico JR. Updated estimates of large and medium vessel strokes, mechanical thrombectomy trends, and future projections indicate a relative flattening of the growth curve but highlight opportunities for expanding endovascular stroke care. J Neurointerv Surg. 2022;0:1–2022–019777. - PMC - PubMed
    1. Goyal M, Menon BK, Van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31. - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–110. - PubMed
    1. Jolugbo P, Ariëns RAS. Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischemic stroke. Stroke. 2021;52(3):1131–42. - PMC - PubMed
    1. Kramer MCA, Van Der Wal AC, Koch KT, Ploegmakers JP, van der Schaaf RJ, Henriques JPS, et al. Presence of older thrombus is an independent predictor of long-term mortality in patients with ST-elevation myocardial infarction treated with thrombus aspiration during primary percutaneous coronary intervention. Circulation. 2008;118(18):1810–6. - PubMed

MeSH terms

LinkOut - more resources