Staessens Senna, Vandelanotte Sarah, François Olivier, Boulleaux Eric, Bretzner Martin, Casolla Barbara, Corseaux Delphine, Puy Laurent, Denorme Frederik, De Wilde Maaike, Desender Linda, Laridan Elodie, Vandenbulcke Aline, de Boer Jasper, Vens Celine, De Sloovere Anne-Sophie, Dewaele Tom, Vanacker Peter, Susen Sophie, Tersteeg Claudia, Vanhoorelbeke Karen, Cordonnier Charlotte, Andersson Tommy, De Meyer Simon F
Laboratory for Thrombosis Research (S. Staessens, S.V., F.D., M.D.W., L.D., E.L., A.V., C.T., K.V., S.F.D.M.), KU Leuven Kulak, Kortrijk Belgium.
Departments of Medical Imaging (O.F., A.-S.D.S., T.D., T.A.), AZ Groeninge, Kortrijk, Belgium.
Stroke. 2025 Apr;56(4):1026-1035. doi: 10.1161/STROKEAHA.124.047092. Epub 2025 Mar 24.
In ischemic stroke due to large vessel occlusion, cerebral blood flow is impaired by thromboemboli, which can originate from various sources in the body. A better understanding of thromboembolus composition can improve our understanding of the underlying pathophysiology and potentially guide improvement of prevention strategies. The aim of this study therefore was to perform a large-sample multi-parameter quantitative histological analysis of retrieved thromboemboli from stroke patients.
Thromboemboli (n=501) were collected from thrombectomy-treated ischemic stroke patients at AZ Groeninge Hospital (Kortrijk, Belgium) and CHU Lille (Lille, France). Stroke etiology was determined by the treating stroke specialist using the TOAST classification system (Trial of ORG 10172 in Acute Stroke Treatment). Extensive histological analysis, blinded to stroke etiology, was performed for key thrombus constituents including red blood cells (RBCs), platelets, fibrin, von Willebrand Factor, leukocytes, citrullinated histone H3 (as a marker for neutrophil extracellular traps), and extracellular (ex)DNA. Quantitative histology results were linked to etiology.
Compared with large-artery atherosclerotic thromboemboli, cardioembolic thromboemboli contained significantly fewer RBCs and significantly more platelets, fibrin, leukocytes, and exDNA. Interestingly, cryptogenic thromboemboli contained relatively low amounts of RBCs and high amounts of platelets, similar to cardioembolic thromboemboli. A multivariable logistic regression model indicated that it is difficult to predict stroke etiology based on the individual thrombus composition.
Based on a large sample cohort of stroke thromboemboli, we found that cardiac thromboemboli contained fewer RBCs and more platelets than atherosclerotic thromboemboli and that cryptogenic thromboemboli have a similar composition to cardiac thromboemboli in terms of RBCs and platelets.
在大血管闭塞所致的缺血性卒中中，脑血流因血栓栓子而受损，这些栓子可源自身体的各种部位。更好地了解血栓栓子的组成可以增进我们对潜在病理生理学的理解，并有可能指导预防策略的改进。因此，本研究的目的是对卒中患者取出的血栓栓子进行大样本多参数定量组织学分析。
从比利时科特赖克的AZ Groeninge医院和法国里尔的CHU Lille接受血栓切除术治疗的缺血性卒中患者中收集血栓栓子（n = 501）。卒中病因由治疗卒中的专科医生使用TOAST分类系统（急性卒中治疗中ORG 10172试验）确定。对包括红细胞（RBC）、血小板、纤维蛋白、血管性血友病因子、白细胞、瓜氨酸化组蛋白H3（作为中性粒细胞胞外陷阱的标志物）和细胞外（ex）DNA在内的关键血栓成分进行了广泛的组织学分析，分析过程对卒中病因设盲。定量组织学结果与病因相关联。
与大动脉粥样硬化性血栓栓子相比，心源性血栓栓子含有的红细胞明显较少，而血小板、纤维蛋白、白细胞和exDNA明显较多。有趣的是，隐源性血栓栓子含有的红细胞相对较少，血小板较多，与心源性血栓栓子相似。多变量逻辑回归模型表明，基于单个血栓成分很难预测卒中病因。
基于一大组卒中血栓栓子样本，我们发现心脏血栓栓子比动脉粥样硬化性血栓栓子含有的红细胞更少，血小板更多，并且隐源性血栓栓子在红细胞和血小板方面的组成与心脏血栓栓子相似。
