Kosyakovsky Jacob, Rossitto Christina P, Antonios Joseph P, Renedo Daniela, Stapleton Christopher J, Sansing Lauren H, Navaratnam Dhasakumar S, Giles James A, Patel Aman B, Matouk Charles C, Sujijantarat Nanthiya
Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA 02115, USA.
Department of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT 06510, USA.
J Clin Med. 2025 Sep 2;14(17):6203. doi: 10.3390/jcm14176203.
Acute ischemic stroke (AIS) is one of the leading global causes of mortality and morbidity. Clearer understanding of stroke etiology is a major clinical objective to determine appropriate strategies for secondary stroke prevention. Histological and molecular analysis of clots retrieved during mechanical thrombectomy (MT) in AIS offers a unique opportunity to study clot composition and its relation to stroke etiology. The field of clot composition analysis has undergone substantial growth in recent years, driven in part by the establishment of MT as the standard of care, as well as its expanding indications. Although many features differ between large-artery atherosclerosis (LAA) and cardioembolic (CE) clots, application of these findings to predicting stroke etiology at a clinical level remains challenging. Moreover, a significant number of patients have multiple comorbidities or suffer a cryptogenic subtype. Next-generation techniques such as multiomic sequencing offer a powerful potential to elevate our understanding of clot pathology and provide the level of granularity required for clinical diagnosis and management. Herein, we provide an updated review of the current state of the field by exploring stroke etiologies and their relationship to clot pathology, including classic histologic features as well as more recent, emerging results from proteomic and transcriptomic analyses.
急性缺血性卒中（AIS）是全球死亡和发病的主要原因之一。更清楚地了解卒中病因是确定二级卒中预防合适策略的主要临床目标。对AIS患者机械取栓（MT）过程中取出的血栓进行组织学和分子分析，为研究血栓成分及其与卒中病因的关系提供了独特的机会。近年来，血栓成分分析领域取得了显著进展，部分原因是MT成为了标准治疗方法，其适应证也在不断扩大。尽管大动脉粥样硬化（LAA）血栓和心源性栓塞（CE）血栓在许多特征上存在差异，但将这些发现应用于临床层面预测卒中病因仍具有挑战性。此外，相当数量的患者有多种合并症或患有隐源性亚型。多组学测序等新一代技术具有强大的潜力，可提升我们对血栓病理学的理解，并提供临床诊断和管理所需的精细程度。在此，我们通过探讨卒中病因及其与血栓病理学的关系，包括经典组织学特征以及蛋白质组学和转录组学分析的最新成果，对该领域的现状进行了更新综述。
