Histological stroke clot analysis after thrombectomy: Technical aspects and recommendations

The recent advent of endovascular procedures has created the unique opportunity to collect and analyze thrombi removed from cerebral arteries, instigating a novel subfield in stroke research. Insights into thrombus characteristics and composition could play an important role in ongoing efforts to improve acute ischemic stroke therapy. An increasing number of centers are collecting stroke thrombi. This paper aims at providing guiding information on thrombus handling, procedures, and analysis in order to facilitate and standardize this emerging research field.

[1]  Allen M. Gown,et al.  Complete Chromogen Separation and Analysis in Double Immunohistochemical Stains Using Photoshop-based Image Analysis , 1999, The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society.

[2]  P. Vespa,et al.  Analysis of Thrombi Retrieved From Cerebral Arteries of Patients With Acute Ischemic Stroke , 2006, Stroke.

[3]  M. Hill,et al.  Calcification and endothelialization of thrombi in acute stroke , 2008, Annals of neurology.

[4]  Keerthana Prasad,et al.  Image Analysis Tools for Evaluation of Microscopic Views of Immunohistochemically Stained Specimen in Medical Research–a Review , 2012, Journal of Medical Systems.

[5]  N. Salamon,et al.  CT and MRI Early Vessel Signs Reflect Clot Composition in Acute Stroke , 2011, Stroke.

[6]  A. Wakhloo,et al.  Mechanical Characterization of Thromboemboli in Acute Ischemic Stroke and Laboratory Embolus Analogs , 2011, American Journal of Neuroradiology.

[7]  M. Reinhard,et al.  Immunohistochemical Analysis of Thrombi Retrieved During Treatment of Acute Ischemic Stroke: Does Stent-Retriever Cause Intimal Damage? , 2013, Stroke.

[8]  I. C. van der Schaaf,et al.  Histopathologic Composition of Cerebral Thrombi of Acute Stroke Patients Is Correlated with Stroke Subtype and Thrombus Attenuation , 2014, PloS one.

[9]  C. Zimmer,et al.  The Impact of Histological Clot Composition in Embolic Stroke , 2016, Clinical Neuroradiology.

[10]  R. Dowling,et al.  Thrombus composition in acute ischemic stroke: a histopathological study of thrombus extracted by endovascular retrieval. , 2015, Journal of neuroradiology. Journal de neuroradiologie.

[11]  Man-Seok Park,et al.  Histologic Analysis of Retrieved Clots in Acute Ischemic Stroke: Correlation with Stroke Etiology and Gradient-Echo MRI , 2015, American Journal of Neuroradiology.

[12]  Hester F. Lingsma,et al.  A randomized trial of intraarterial treatment for acute ischemic stroke. , 2015, The New England journal of medicine.

[13]  M. Krause,et al.  Endovascular therapy for ischemic stroke with perfusion-imaging selection. , 2015, The New England journal of medicine.

[14]  A. Demchuk,et al.  Thrombectomy within 8 hours after symptom onset in ischemic stroke. , 2015, The New England journal of medicine.

[15]  Eric E. Smith,et al.  Randomized assessment of rapid endovascular treatment of ischemic stroke. , 2015, The New England journal of medicine.

[16]  H. Diener,et al.  Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. , 2015, The New England journal of medicine.

[17]  J. Kira,et al.  Histopathologic Analysis of Retrieved Thrombi Associated With Successful Reperfusion After Acute Stroke Thrombectomy , 2016, Stroke.

[18]  A. Qureshi,et al.  Histopathological Characteristics of IV Recombinant Tissue Plasminogen -Resistant Thrombi in Patients with Acute Ischemic Stroke. , 2016, Journal of vascular and interventional neurology.

[19]  J. Heo,et al.  Histologic features of acute thrombi retrieved from stroke patients during mechanical reperfusion therapy , 2016, International journal of stroke : official journal of the International Stroke Society.

[20]  C. Kleinschnitz,et al.  Immunohistochemical Analysis of Cerebral Thrombi Retrieved by Mechanical Thrombectomy from Patients with Acute Ischemic Stroke , 2016, International journal of molecular sciences.

[21]  L. Desender,et al.  ADAMTS13-mediated thrombolysis of t-PA-resistant occlusions in ischemic stroke in mice. , 2016, Blood.

[22]  C. Zimmer,et al.  Thrombus Histology Suggests Cardioembolic Cause in Cryptogenic Stroke , 2016, Stroke.

[23]  P. Stanzione,et al.  Histological Features of Intracranial Thrombo-Emboli Predict Response to Endovascular Therapy for Acute Ischemic Stroke , 2016 .

[24]  V. Costes,et al.  High CD3+ Cells in Intracranial Thrombi Represent a Biomarker of Atherothrombotic Stroke , 2016, PloS one.

[25]  W. Hacke,et al.  Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review , 2016, Journal of NeuroInterventional Surgery.

[26]  Tommy Andersson,et al.  Thrombectomy in Acute Ischemic Stroke: Challenges to Procedural Success , 2017, Journal of stroke.

[27]  W. Heindel,et al.  Ischemic Stroke: What Does the Histological Composition Tell Us About the Origin of the Thrombus? , 2017, Stroke.

[28]  Hong Wang,et al.  An Inexpensive Digital Image Analysis Technique for Liver Fibrosis Quantification in Chronic Hepatitis B Patients. , 2017, Annals of hepatology.

[29]  Ellen T. Arena,et al.  Quantitating the cell: turning images into numbers with ImageJ , 2017, Wiley interdisciplinary reviews. Developmental biology.

[30]  G. Serrano-Heras,et al.  Histopathological and Bacteriological Analysis of Thrombus Material Extracted During Mechanical Thrombectomy in Acute Stroke Patients , 2017, CardioVascular and Interventional Radiology.

[31]  P. Brouwer,et al.  Clot friction variation with fibrin content; implications for resistance to thrombectomy , 2017, Journal of NeuroInterventional Surgery.

[32]  A. Demchuk,et al.  Analyses of thrombi in acute ischemic stroke: A consensus statement on current knowledge and future directions , 2017, International journal of stroke : official journal of the International Stroke Society.

[33]  W. Heindel,et al.  Ischemic Stroke: Histological Thrombus Composition and Pre-Interventional CT Attenuation Are Associated with Intervention Time and Rate of Secondary Embolism , 2017, Cerebrovascular Diseases.

[34]  L. Desender,et al.  Neutrophil extracellular traps in ischemic stroke thrombi , 2017, Annals of neurology.

[35]  C. Zimmer,et al.  The CD31 molecule: a possible neuroprotective agent in acute ischemic stroke? , 2017, Thrombosis Journal.

[36]  M. Fornage,et al.  Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association , 2017, Circulation.

[37]  T. Huber,et al.  Risk of Thrombus Fragmentation during Endovascular Stroke Treatment , 2017, American Journal of Neuroradiology.

[38]  J. Michel,et al.  Thrombus Neutrophil Extracellular Traps Content Impair tPA-Induced Thrombolysis in Acute Ischemic Stroke , 2018, Stroke.

[39]  C. Zimmer,et al.  Impact of histological thrombus composition on preinterventional thrombus migration in patients with acute occlusions of the middle cerebral artery , 2018, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[40]  J. Weisel,et al.  The Role of von Willebrand Factor, ADAMTS13, and Cerebral Artery Thrombus Composition in Patient Outcome Following Mechanical Thrombectomy for Acute Ischemic Stroke , 2018, Medical science monitor : international medical journal of experimental and clinical research.

[41]  C. Zimmer,et al.  Artificial Stroke Clots: How Wide is the Gap to the Real World? , 2017, World neurosurgery.

[42]  O. Vysata,et al.  Fibrin Clot Architecture in Acute Ischemic Stroke Treated With Mechanical Thrombectomy With Stent-Retrievers - Cohort Study. , 2017, Circulation journal : official journal of the Japanese Circulation Society.

[43]  T. Sano,et al.  Erythrocyte-Rich Thrombus Is Associated with Reduced Number of Maneuvers and Procedure Time in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy , 2018, Cerebrovascular Diseases Extra.

[44]  H. Jeong,et al.  High red blood cell composition in clots is associated with successful recanalization during intra-arterial thrombectomy , 2018, PloS one.

[45]  Seong-Joon Lee,et al.  Erythrocyte Fraction Within Retrieved Thrombi Contributes to Thrombolytic Response in Acute Ischemic Stroke , 2018, Stroke.

[46]  C. Zimmer,et al.  Thrombus Permeability in Admission Computed Tomographic Imaging Indicates Stroke Pathogenesis Based on Thrombus Histology , 2018, Stroke.

[47]  G. Gigli,et al.  Dynamic Hyperglycemic Patterns Predict Adverse Outcomes in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy , 2020, Journal of clinical medicine.