Histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke: a study of atypical clots
IntroductionClot composition appears to be associated with outcomes in stroke recanalization therapy. This study aims to analyze thrombus composition and assess the relationship between atypical clot composition and clinical parameters, laboratory markers, and recanalization strategies in a series o...
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Frontiers Media S.A.
2025-03-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1563371/full |
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| author | Laura Rojas-Bartolomé María Payá Rosa Barbella-Aponte Laura Restrepo Carvajal Jorge García-García Oscar Ayo-Martín Juan David Molina-Nuevo Gemma Serrano-Heras Enrique Juliá-Molla María José Pedrosa-Jiménez Lorena López-Martínez Ángela Fernández López Tomás Segura Tomás Segura Francisco Hernández-Fernández Francisco Hernández-Fernández |
| author_facet | Laura Rojas-Bartolomé María Payá Rosa Barbella-Aponte Laura Restrepo Carvajal Jorge García-García Oscar Ayo-Martín Juan David Molina-Nuevo Gemma Serrano-Heras Enrique Juliá-Molla María José Pedrosa-Jiménez Lorena López-Martínez Ángela Fernández López Tomás Segura Tomás Segura Francisco Hernández-Fernández Francisco Hernández-Fernández |
| author_sort | Laura Rojas-Bartolomé |
| collection | DOAJ |
| description | IntroductionClot composition appears to be associated with outcomes in stroke recanalization therapy. This study aims to analyze thrombus composition and assess the relationship between atypical clot composition and clinical parameters, laboratory markers, and recanalization strategies in a series of patients with acute ischemic stroke (AIS) undergoing endovascular treatment (EVT).MethodsThis is a prospective single-center registry conducted from December 2014 to July 2022. All retrieved clots were examined under an established protocol and classified as follows: red blood cell-rich clots (RBC), fibrin/platelet-rich clots (FPC), mixed clots (MC), septic emboli (SE), atheroma emboli (AE), fatty emboli (FE), and calcium emboli (CE). We categorized them into two groups: atypical clot composition (ACC: SE, AE, FE, and CE) and usual clot composition (UCC: RBC, FPC, and MC). A subgroup of 10 ACC (four SE, three AE, two FE, and one CE) and nine UCC (three RBC, three FPC, and three MC), matched by age and sex, was analyzed using immunohistochemistry to detect neutrophil extracellular traps (NETs).ResultsA total of 606 patients were assessed for EVT, with 448 (73.92%) meeting the inclusion criteria. The clot categorization was as follows: FPC 211 (47.1%), RBC 105 (23.4%), MC 104 (23.2%), SE 16 (3.6%), AE 5 (1.1%), CE 4 (0.9%), and FE 3 (0.7%). Consequently, we classified 420 (93.75%) patients into the UCC group and 28 (6.25%) into the ACC group. Bivariate analysis revealed that the ACC group had a significantly higher number of leukocytes (11.40 leukocytes/mm3 vs. 9.49, p = 0.005), a greater frequency of TICA occlusion (28.6% vs. 9.8%, p = 0.006), and higher mortality at three months (28.6% vs. 12.4%, p = 0.038). Multivariate analysis indicated that atypical clot composition was significantly associated with a higher prevalence of diabetes mellitus, smoking, occlusion of the terminal internal carotid artery, and an increased number of passes. Immunohistochemical studies showed the presence of neutrophil extracellular traps (NETs) in all 19 thrombi that were analyzed.ConclusionDiabetes and TICA occlusion were the strongest predictors of atypical clot composition. We also observed a significant association between atypical composition and an increased number of passes. Furthermore, the presence of NETs in all thrombi analyzed, regardless of their composition, indicates inflammatory mechanisms associated with clot formation and consolidation in AIS. |
| format | Article |
| id | doaj-art-ab15b28d83ae4f1b9854bc91a67fe6dd |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-ab15b28d83ae4f1b9854bc91a67fe6dd2025-08-20T03:42:30ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-03-011610.3389/fneur.2025.15633711563371Histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke: a study of atypical clotsLaura Rojas-Bartolomé0María Payá1Rosa Barbella-Aponte2Laura Restrepo Carvajal3Jorge García-García4Oscar Ayo-Martín5Juan David Molina-Nuevo6Gemma Serrano-Heras7Enrique Juliá-Molla8María José Pedrosa-Jiménez9Lorena López-Martínez10Ángela Fernández López11Tomás Segura12Tomás Segura13Francisco Hernández-Fernández14Francisco Hernández-Fernández15Department of Neurology, University General Hospital of Albacete, Albacete, SpainDepartment of Neurology, University General Hospital of Albacete, Albacete, SpainDepartment of Surgical Pathology, University General Hospital of Albacete, Albacete, SpainDepartment of Neurology, University General Hospital of Albacete, Albacete, SpainDepartment of Neurology, University General Hospital of Albacete, Albacete, SpainDepartment of Neurology, University General Hospital of Albacete, Albacete, SpainDepartment of Radiology, University General Hospital of Albacete, Albacete, SpainResearch Unit, University General Hospital of Albacete, Albacete, SpainDepartment of Radiology, University General Hospital of Albacete, Albacete, SpainDepartment of Radiology, University General Hospital of Albacete, Albacete, SpainDepartment of Radiology, University General Hospital of Albacete, Albacete, SpainDepartment of Radiology, University General Hospital of Albacete, Albacete, SpainDepartment of Neurology, University General Hospital of Albacete, Albacete, SpainMedical School, Biomedicine Institute (IB), University of Castilla-La Mancha (UCLM), Albacete, SpainDepartment of Neurology, University General Hospital of Albacete, Albacete, SpainDepartment of Radiology, University General Hospital of Albacete, Albacete, SpainIntroductionClot composition appears to be associated with outcomes in stroke recanalization therapy. This study aims to analyze thrombus composition and assess the relationship between atypical clot composition and clinical parameters, laboratory markers, and recanalization strategies in a series of patients with acute ischemic stroke (AIS) undergoing endovascular treatment (EVT).MethodsThis is a prospective single-center registry conducted from December 2014 to July 2022. All retrieved clots were examined under an established protocol and classified as follows: red blood cell-rich clots (RBC), fibrin/platelet-rich clots (FPC), mixed clots (MC), septic emboli (SE), atheroma emboli (AE), fatty emboli (FE), and calcium emboli (CE). We categorized them into two groups: atypical clot composition (ACC: SE, AE, FE, and CE) and usual clot composition (UCC: RBC, FPC, and MC). A subgroup of 10 ACC (four SE, three AE, two FE, and one CE) and nine UCC (three RBC, three FPC, and three MC), matched by age and sex, was analyzed using immunohistochemistry to detect neutrophil extracellular traps (NETs).ResultsA total of 606 patients were assessed for EVT, with 448 (73.92%) meeting the inclusion criteria. The clot categorization was as follows: FPC 211 (47.1%), RBC 105 (23.4%), MC 104 (23.2%), SE 16 (3.6%), AE 5 (1.1%), CE 4 (0.9%), and FE 3 (0.7%). Consequently, we classified 420 (93.75%) patients into the UCC group and 28 (6.25%) into the ACC group. Bivariate analysis revealed that the ACC group had a significantly higher number of leukocytes (11.40 leukocytes/mm3 vs. 9.49, p = 0.005), a greater frequency of TICA occlusion (28.6% vs. 9.8%, p = 0.006), and higher mortality at three months (28.6% vs. 12.4%, p = 0.038). Multivariate analysis indicated that atypical clot composition was significantly associated with a higher prevalence of diabetes mellitus, smoking, occlusion of the terminal internal carotid artery, and an increased number of passes. Immunohistochemical studies showed the presence of neutrophil extracellular traps (NETs) in all 19 thrombi that were analyzed.ConclusionDiabetes and TICA occlusion were the strongest predictors of atypical clot composition. We also observed a significant association between atypical composition and an increased number of passes. Furthermore, the presence of NETs in all thrombi analyzed, regardless of their composition, indicates inflammatory mechanisms associated with clot formation and consolidation in AIS.https://www.frontiersin.org/articles/10.3389/fneur.2025.1563371/fullatypical clotischemic strokemechanical thrombectomyhistopathologicalseptic emboli |
| spellingShingle | Laura Rojas-Bartolomé María Payá Rosa Barbella-Aponte Laura Restrepo Carvajal Jorge García-García Oscar Ayo-Martín Juan David Molina-Nuevo Gemma Serrano-Heras Enrique Juliá-Molla María José Pedrosa-Jiménez Lorena López-Martínez Ángela Fernández López Tomás Segura Tomás Segura Francisco Hernández-Fernández Francisco Hernández-Fernández Histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke: a study of atypical clots Frontiers in Neurology atypical clot ischemic stroke mechanical thrombectomy histopathological septic emboli |
| title | Histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke: a study of atypical clots |
| title_full | Histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke: a study of atypical clots |
| title_fullStr | Histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke: a study of atypical clots |
| title_full_unstemmed | Histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke: a study of atypical clots |
| title_short | Histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke: a study of atypical clots |
| title_sort | histopathological composition of thrombus material in a large cohort of patients with acute ischemic stroke a study of atypical clots |
| topic | atypical clot ischemic stroke mechanical thrombectomy histopathological septic emboli |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1563371/full |
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