Thrombo-CARE-cardioembolic stroke etiology in cryptogenic stroke suggested by fibrin-/platelet-rich clot history: Thrombo-CARE (configuration analysis to refine etiology)
Sprache des Titels:
Englisch
Original Kurzfassung:
Background Despite extensive diagnostic efforts,
the etiology of stroke remains unclear in up to 30%
of patients. Mechanical thrombectomy (MT) potentially enhances etiological determination by (immuno)histological analysis of retrieved thrombotic
material.
Methods In this monocentric exploratory study, clots
from 200 patients undergoing MT were investigated
by hematoxylin and eosin, CD3, and CD45 staining. Semiquantitative and computer-based image
analysis defined the histological composition and
relative fractions of immunohistochemically stained
areas. First, we correlated these results with strokes
of known etiology. Subsequently, clots of unknown
source were characterized with regard to their (immuno)histological profile to attempt etiological classification. Results Samples from 198 patients were accessible
for analysis. Fibrin-/platelet-rich histology appeared
in 45 (23%), erythrocyte-rich in 18 (9%), and mixed
histology in 123 (62%) patients. Etiology was classified as cardioembolic in 87 (44%), arterioembolic in
37 (19%), and as cryptogenic stroke (CS) in 26 (13%)
cases. 20 (23%) patients with cardioembolic stroke
and 5 (14%) patients with arterioembolic stroke had
fibrin-/platelet-rich clots. 8 (22%) patients with arterioembolic stroke and 1 (1%) patient with cardioembolic stroke had erythrocyte-rich clots. In CS, cardioembolic clot features appeared more than twice as
often as arterioembolic clot features. Whereas the association between histology and etiology was significant (p= 0.0057), CD3/CD45 staining did not correlate.
Conclusion A significant association between histology and etiology was observed, with the proportion of erythrocyte-rich thrombi being largest among arterioembolic strokes and the proportion of fibrin-/
platelet-rich thrombi highest among cardioembolic
strokes. A high number of clots from CS presented
histological features of cardioembolic clots. Thus,
patients with CS and fibrin-/platelet-rich clots particularly require long-term cardiac rhythm monitoring
and may benefit from oral anticoagulation.
Forschungs-