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An old thrombus may potentially identify patients at higher risk of poor outcome in anterior circulation stroke undergoing thrombectomy

  • Interventional Neuroradiology
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Abstract

Purpose

To investigate thrombus age and its association with clinical and procedural parameters in patients with acute ischemic stroke (AIS) due to anterior circulation occlusions.

Methods

The thrombi of 107 consecutive AIS patients with occlusions in anterior circulation large-arteries were collected during mechanical recanalization. By hematoxylin–eosin staining analysis, thrombi were classified as fresh (< 3 days) or old (≥ 3 days) according to the hemosiderin positivity. Old thrombi were further classified as thrombi with focal hemosiderin or diffuse hemosiderin according to their predominant distribution. Neuro-interventional data and clinical outcomes were compared based on thrombus age.

Results

We identified fresh thrombi in 29 patients and old thrombi in 78 patients. Compared with patients with fresh thrombi, patients with old thrombi were associated with (i) a longer mechanical recanalization time (p = 0.027), (ii) a higher percentage of fibrin/platelets and leukocytes (all p = 0.02) and a lower percentage of erythrocytes (p = 0.001), and (iii) less favorable clinical outcomes at discharge (p = 0.019) and 90 days later (OR = 2.76, 95% CI = 1.09–6.99, p = 0.032). Furthermore, 18 (16.8%) of all patients had focal hemosiderin in old thrombi, which was independently linked to a poor clinical outcome 90 days later (adjusted OR = 5.37, 95% CI = 1.14–25.28, p = 0.034).

Conclusion

The presence of old thrombi, particularly those with focal hemosiderin, may aid in identifying patients with acute ischemic anterior circulation stroke who are at a higher risk of poor clinical outcome at 3-month follow-up.

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Acknowledgements

All authors contributed to the article. We would like to thank Editorbar (www.editorbar.com) for English language editing.

Funding

This work was supported by the National Natural Science Foundation of China (Grant number 81971120), the Natural Science Foundation of Guangdong Province (Grant number 2022A1515012563), and the Basic and Applied Basic Research on the Project Jointly Funded by Guangzhou city and Jinan University (Grant number 202201020062).

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Author notes

  1. Jia’xing Lin and Min Guan contributed to this work equally.

Authors and Affiliations

  1. Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, NO.613 the West of Huangpu street, Guangzhou, 510630, China

    Jia’xing Lin, Min Guan, Yu Liao, Liang Zhang, Hong’yu Qiao & Li’an Huang

  2. Department of Pathology, The First Affiliated Hospital, Jinan University, Guangzhou, China

    Yu Liao

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  1. Jia’xing Lin
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Contributions

Li’an Huang contributed to the design of the study and edited the manuscript. Jia’xing Lin performed data analyses and wrote the manuscript. Jia’xing Lin and Liang Zhang contributed towards the patient recruitment. Min Guan, Yu Liao, and Hong’yu Qiao interpreted and measured the specimens and images.

All authors contributed to the article.

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Correspondence to Li’an Huang.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board of the First Affiliated Hospital of Jinan University approved this study.

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Lin, J., Guan, M., Liao, Y. et al. An old thrombus may potentially identify patients at higher risk of poor outcome in anterior circulation stroke undergoing thrombectomy. Neuroradiology 65, 381–390 (2023). https://doi.org/10.1007/s00234-022-03069-7

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  • DOI: https://doi.org/10.1007/s00234-022-03069-7

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