학술논문
Prognostic Value of Histopathological Thrombus Age in Large Vessel Occlusion-Related Stroke.
Document Type
Academic Journal
Author
Gorsel BV; Amphia Hospital, Breda, The Netherlands.; Remmers MJM; Amphia Hospital, Breda, The Netherlands.; Vos LD; Amphia Hospital, Breda, The Netherlands.; Scholzel BE; Amphia Hospital, Breda, The Netherlands.; Haans DAW; Amphia Hospital, Breda, The Netherlands.; Aarts RAHM; Amphia Hospital, Breda, The Netherlands.; Versteylen RJ; Amphia Hospital, Breda, The Netherlands.; Van Norden AGW; Amphia Hospital, Breda, The Netherlands.; Van Oers CAMM; Amphia Hospital, Breda, The Netherlands.; Vos J; Amphia Hospital, Breda, The Netherlands.; IJsselmuiden SJJ; Amphia Hospital, Breda, The Netherlands.; Van Den Branden BJL; Amphia Hospital, Breda, The Netherlands.; De Boer OJ; Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Imani F; Amphia Hospital, Breda, The Netherlands.; Alings M; Amphia Hospital, Breda, The Netherlands.; Pertiwi KR; Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; De Winter RJ; Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Miah I; Amphia Hospital, Breda, The Netherlands.; Van Der Wal AC; Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Van De Hoef TP; UMC Utrecht, University Medical Center, Utrecht, The Netherlands.; Meuwissen M; Amphia Hospital, Breda, The Netherlands.
Source
Publisher: Karger Country of Publication: Switzerland NLM ID: 101577885 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1664-5456 (Electronic) Linking ISSN: 16645456 NLM ISO Abbreviation: Cerebrovasc Dis Extra Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Acute mechanical thrombectomy (MT) is the preferred treatment for large vessel occlusion-related stroke. Histopathological research on the obtained occlusive embolic thrombus may provide information regarding the aetiology and pathology of the lesion to predict prognosis and propose possible future acute ischaemic stroke therapy.
Methods: A total of 75 consecutive patients who presented to the Amphia Hospital with acute large vessel occlusion-related stroke and underwent MT were included in the study. The obtained thrombus materials were subjected to standard histopathological examination. Based on histological criteria, they were considered fresh (<1 day old) or old (>1 day old). Patients were followed for 2 years for documentation of all-cause mortality.
Results: Thrombi were classified as fresh in 40 patients (53%) and as older in 35 patients (47%). Univariate Cox regression analysis showed that thrombus age, National Institutes of Health Stroke Scale at hospital admission, and patient age were associated with long-term mortality (p < 0.1). Multivariable Cox hazards and Kaplan-Meier analysis demonstrated that after extensive adjustment for clinical and procedural variables, thrombus age persisted in being independently associated with higher long-term mortality (hazard ratio: 3.34; p = 0.038, log-rank p = 0.013).
Conclusion: In this study, older thromboemboli are responsible for almost half of acute large ischaemic strokes. Moreover, the presence of an old thrombus is an independent predictor of mortality in acute large vessel occlusion-related stroke. More research is warranted regarding future therapies based on thrombus composition.
(© 2023 The Author(s). Published by S. Karger AG, Basel.)
Methods: A total of 75 consecutive patients who presented to the Amphia Hospital with acute large vessel occlusion-related stroke and underwent MT were included in the study. The obtained thrombus materials were subjected to standard histopathological examination. Based on histological criteria, they were considered fresh (<1 day old) or old (>1 day old). Patients were followed for 2 years for documentation of all-cause mortality.
Results: Thrombi were classified as fresh in 40 patients (53%) and as older in 35 patients (47%). Univariate Cox regression analysis showed that thrombus age, National Institutes of Health Stroke Scale at hospital admission, and patient age were associated with long-term mortality (p < 0.1). Multivariable Cox hazards and Kaplan-Meier analysis demonstrated that after extensive adjustment for clinical and procedural variables, thrombus age persisted in being independently associated with higher long-term mortality (hazard ratio: 3.34; p = 0.038, log-rank p = 0.013).
Conclusion: In this study, older thromboemboli are responsible for almost half of acute large ischaemic strokes. Moreover, the presence of an old thrombus is an independent predictor of mortality in acute large vessel occlusion-related stroke. More research is warranted regarding future therapies based on thrombus composition.
(© 2023 The Author(s). Published by S. Karger AG, Basel.)