Histopathological Study of Thrombi Retrieved from Cerebral Arteries following Mechanical Thrombectomy and Correlation with Radiographic, Clinical Outcomes and Origin of the Thrombus

Abdulrahman Mostafa Ibrahim; Rania Gaber Mohamed Ali; Hany Mohamed Ibrahim Eldeep; Ossama Yassin Mansour

Abdulrahman Mostafa Ibrahim Assistant lecturer of Neurology Department, Faculty of Medicine, University Hospital of Alexandria, Alexandria, Egypt
Rania Gaber Mohamed Ali
Hany Mohamed Ibrahim Eldeep
Ossama Yassin Mansour

Keywords: Thrombi, Cerebral Arteries, Thrombectomy, Radiography

Abstract

Background: Advancements in endovascular methods for addressing strokes resulting from major cerebral artery occlusions have facilitated the examination of recovered thrombus material, offering a significant avenue to improve the determination of stroke causes. This study aimed to investigate the immuno-histopathological features of clots retrieved through mechanical thrombectomy in individuals with acute ischemic stroke (AIS).

Methods: A total of 22 consecutive patients, aged 18 years or older, were included in this study. All had experienced an acute ischemic stroke caused by large vessel occlusion (LVO) and underwent endovascular thrombectomy at our facility between September 2021 and June 2023. The thrombi extracted during the procedure were subsequently subjected to detailed histopathological analysis.

Results: There were significant differences found between clot composition (WBC, fibrin, and RBC groups) and several factors including ischemic heart disease (IHD), stroke cause, ASPECT score, collateral score, NIHSS immediately post-procedure, mRS at discharge, procedure duration, eTICI, number of passes, and brain edema (P<0.05). The ASPECT and collateral scores were higher in the WBC group compared to the fibrin and RBC groups (P<0.05). Additionally, clot composition influenced immediate post-procedural NIHSS, mRS at discharge, brain edema, and hemorrhage (P<0.05). The fibrin group had a significantly longer procedure duration, and more passes compared to the RBC and WBC groups (P<0.05).

Conclusions: Clot composition was linked to hemorrhage, mRS, and discharge outcomes. Higher CD3 and CD31 levels were associated with better outcomes and higher ASPECT scores. Post-intervention NIHSS and procedure parameters (duration, eTICI) were also associated with CD3.