TY - JOUR
T1 - Prognostic Value of Histopathological Thrombus Age in Large Vessel Occlusion-Related Stroke
AU - Gorsel, Bart Van
AU - Remmers, Michel J. M.
AU - Vos, Louwerens D.
AU - Scholzel, Bas E.
AU - Haans, Dirk A. W.
AU - Aarts, Ruud A. H. M.
AU - Versteylen, Rob J.
AU - van Norden, Anouk G. W.
AU - van Oers, Casper A. M. M.
AU - Vos, Jeroen
AU - IJsselmuiden, Sander J. J.
AU - van den Branden, Ben J. L.
AU - de Boer, Onno J.
AU - Imani, Farshad
AU - Alings, Marco
AU - Pertiwi, Kartika R.
AU - de Winter, Robbert J.
AU - Miah, Ishita
AU - van der Wal, Allard C.
AU - van de Hoef, Tim P.
AU - Meuwissen, Martijn
N1 - Publisher Copyright: © 2023 The Author(s).
PY - 2023/11/6
Y1 - 2023/11/6
N2 - 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.
AB - 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.
KW - Prognosis
KW - Stroke
KW - Thrombectomy
KW - Thrombus
UR - http://www.scopus.com/inward/record.url?scp=85181176703&partnerID=8YFLogxK
U2 - https://doi.org/10.1159/000534937
DO - https://doi.org/10.1159/000534937
M3 - Article
C2 - 37931606
SN - 1664-5456
VL - 13
SP - 97
EP - 104
JO - Cerebrovascular diseases extra
JF - Cerebrovascular diseases extra
IS - 1
ER -