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. 2025 Mar 24:13:e19173.
doi: 10.7717/peerj.19173. eCollection 2025.

Effect of atrial fibrosis on clot burden score and physicochemical properties of thrombus in patients with ischaemic stroke occurring in non-valvular atrial fibrillation

Juan Zhao  1   2 , Guangjun Deng  3 , Weijing Wang  2 , Peng Wang  2 , Xinyu Shen  2 , Xiaoxiao Yuan  2 , Haifei Jiang  4 , Zhong-Bao Ruan  1   5
Affiliations

Effect of atrial fibrosis on clot burden score and physicochemical properties of thrombus in patients with ischaemic stroke occurring in non-valvular atrial fibrillation

Juan Zhao et al. PeerJ. .

Abstract

Background: To investigate the effect of the degree of atrial fibrosis on the clot burden score (CBS) and physicochemical properties in patients with acute ischaemic stroke (AIS) due to non-valvular atrial fibrillation (NVAF).

Methods: A total of 117 patients with AIS in NVAF attending the Department of Cardiovascular Medicine and the Cerebrovascular Diagnostic and Treatment Centre between August 2021 and May 2024 were included in the study. Baseline clinical data, biochemical indexes, and imaging data of the patients were collected, and the patients were divided into 93 cases of the CBS (score of 0-6) group and 24 cases of the CBS (score of 7-10) group according to the CBS. CBS (score of 0-6) signifies higher clot burden. The enzyme-linked immunosorbent assay was used to measure the concentration of galactaglutinin-3 (gal-3) and transforming growth factor (TGF-β1) in the serum of the patients, and the PTFV1 were collected by 12-lead electrocardiogram, and the differences in the degree of atrial fibrosis between different groups and the risk factors of CBS (score of 0-6) were analysed. To analyse the effect of atrial fibrosis on the collateral circulation of stroke, the patients were divided into 31 cases with good collateral circulation (grade 3-4) and 86 cases with poor collateral circulation (grade 0-2) according to the digital subtraction angiography (DSA) images. The cerebral thrombus was collected from 60 AIS patients who underwent mechanical thrombectomy. The content of erythrocyte, fibrin/platelets and leukocytes in the thrombus was analysed by Mathew's scarlet blue staining, and the density of thrombus was measured by computed tomography (CT).

Results: A total of 117 patients were included in this study, and the proportion of hypertensive patients, proportion of chronic atrial fibrillation (CAF), B-type natriuretic peptide (BNP), neutrophil/lymphocyte ratio (NLR), D-dimer, uric acid concentration, proportion of patients with PTFV1 < -0.03 mm s, gal-3, and TGF-β1 were higher in the CBS (score of 0-6) group as compared to the CBS (score of 7-10) group (P-value < 0.05). Hypertension, proportion of CAF, homocysteine, NLR, D-dimer, uric acid, PTFV1 < -0.03 mm s, gal-3, and TGF-β1, were risk factors for the development of high CBS in atrial fibrillation (AF), and hypertension and CAF were the most important factors for the occurrence of AF in the independent risk factors for stroke combined with high clot burden. gal-3 and TGF-β1 were risk factors for poor collateral circulation, atrial fibrosis indexes were not associated with thrombus pathological composition and thrombus density.

Conclusions: Atrial fibrosis increases clot burden in patients with AIS due to NVAF but does not significantly correlate with the physicochemical properties and density of the thrombus.

Keywords: Acute ischemic stroke; Atrial fibrillation; Atrial fibrosis; Clot burden score; Thrombus.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Middle cerebral artery occlusion.
(A, B) Poor compensation of collateral circulation. (C, D) Well compensated by collateral circulation.
Figure 2
Figure 2. Internal carotid artery.
(A, B) Poor compensation of collateral circulation. (C, D) Well compensation of collateral circulation.
Figure 3
Figure 3. The product of the voltage (mm) and the time limit (s) of the negative P-wave was taken as the PTFV1 value.
Figure 4
Figure 4. Examples of clot perviousness measurement.
Contrast-enhanced CT (CECT) showed occlusion in the segment of left middle cerebral artery.
Figure 5
Figure 5. The predictive value of CBS (score of 0–6) group was evaluated by ROC curve.
Figure 6
Figure 6. Thrombus MSB stained section diagrams.
The yellow areas are red blood cells, the blue areas are collagen fibers, and the gray areas are platelets.
Figure 7
Figure 7. Proportion of blood cell composition in 60 patients.
See this image and copyright information in PMC

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