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A nomogram for predicting thrombus composition in stroke patients with large vessel occlusion: combination of thrombus density and perviousness with clinical features

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

To establish a nomogram incorporating pretreatment imaging parameters and clinical characteristics for predicting the thrombus composition of acute ischemic stroke (AIS) with large vessel occlusion (LVO).

Methods

We retrospectively enrolled patients with occlusion of the Middle Cerebral Artery (MCA) who underwent Mechanical Thrombectomy (MT). Retrieved thrombi were stained with Hematoxylin and Eosin (H&E) and Martius Scarlet Blue (MSB). Thrombi are assigned to the Fibrin-rich or RBC-rich group based on the relative fractions of Red Blood Cells (RBC), fibrin, and platelet. The independent risk factors for Fibrin-rich clots were determined via univariate and multivariate logistic regression analysis and were then integrated to establish a nomogram.

Results

In total, 98 patients were included in this study. Patients with fibrin-rich clots had worse functional outcome [modified Rankin scale (mRS) 0–2, 34.7% vs 63.2%, p = 0.005], longer procedure time (76.8 min vs 50.8 min, p = 0.001), and increased maneuvers of MT (1.84 vs 1.46, p = 0.703) than those with RBC-rich clots. The independent risk factors for Fibrin-rich clots were lower perviousness measured by Non-Contrast Computer Tomography (NCCT) and CT Angiography (CTA), lower thrombus relative attenuation on NCCT, elevated Platelet-WBC ratio (PWR) of admission peripheral blood, and previous antithrombotic medication. The nomogram showed good discrimination with an area under the Receiver Operating Characteristic (ROC) curve (AUC) of 0.852 (95% CI: 0.778–0.926). The calibration curve and decision curve analysis also displayed satisfactory accuracy and clinical utility.

Conclusion

This study has developed and internally validated an easy-to-use nomogram which can help predict clot composition and optimize therapeutic strategies for thrombectomy.

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Data availability

All data relevant to the study are included in the article.

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Funding

Project supported by National Natural Science Foundation of China (81971613); Interventional Medicine Research Fund of Jiangsu Medical Association (SYH-3201140–0024).

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Author notes

  1. Chendong Wang and Yu Hang contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China

    Chendong Wang, Yu Hang, Yuezhou Cao, Linbo Zhao, Haibin Shi, Sheng Liu & Zhenyu Jia

  2. Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China

    Jincheng Jiao & Mingfang Li

  3. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China

    Xiaoquan Xu & Shanshan Lu

  4. Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China

    Lei Jiang & Qianghui Liu

Authors
  1. Chendong Wang
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Contributions

WCD and JZY conceived and designed the research. HY, CYZ, and ZLB acquired the data. JJC, LMF, XXQ, LSS, JL, LQH, and SHB analyzed and interpreted the data. WCD and HY drafted the manuscript. LS and JZY made critical revisions to the manuscript. All authors approved the final manuscript.

Corresponding authors

Correspondence to Sheng Liu or Zhenyu Jia.

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The authors declare no competing interests.

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IRB approval was obtained through The First Affiliated Hospital with Nanjing Medical University.

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Wang, C., Hang, Y., Cao, Y. et al. A nomogram for predicting thrombus composition in stroke patients with large vessel occlusion: combination of thrombus density and perviousness with clinical features. Neuroradiology 65, 371–380 (2023). https://doi.org/10.1007/s00234-022-03046-0

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  • DOI: https://doi.org/10.1007/s00234-022-03046-0

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