Correlation of thrombus composition with prognosis of patients with acute cerebral infarction

Abstract

Objective To analyze the correlation between thrombus composition and the prognosis of patients with acute cerebral infarction after mechanical thrombectomy. Methods This retrospective analysis was conducted among 48 patients with the diagnosis of acute ischemic stroke, who were eligible for mechanical thrombectomy as assessed by the first aid group and successfully underwent the surgery between June, 2015 and February, 2019. The clinical data were collected from the patients including TOAST(trail of org 10172 in acute stroke treatment) classification, thrombus position, number of stents placed, recanalization time, thrombolysis in cerebral infarction (TICI) grading and the use of recombinant tissue plasminogen activator (rt-PA) for intravenous thrombolysis. The patients were followed up and the modified Rankin scale (mRS) score at 3 months after the surgery was recorded. The composition of the retrieved thrombus was examined using HE staining, and the correlation between thrombus composition and the patients' outcomes was analyzed. Results Of the 48 patients included, 24 were diagnosed to have cardioembolic stroke, 16 had large artery atherosclerotic stroke, and 8 had stroke with unknown etiology. A significant difference was found in fibrin and platelet contents between the cardiogenic thrombi and atherosclerotic thrombi. Fibrin-rich thrombi were found in 35 patients, and erythrocyte-rich thrombi were found in 13 patients; the percentage of favorable mRS scores at the end of the third month after the surgery was significantly lower in the former patients than in the latter patients (26% vs 62%, P < 0.05). During mechanical thrombectomy, the recanalization time was significantly shorter in patients receiving intravenous thrombolysis with rt-PA than in those without the use of rt-PA (90±47.6 vs 131.6 ± 57.5 min, P < 0.05). Conclusion In patients with acute ischemic stroke undergoing mechanical thrombectomy, high fibrin and platelet contents in the thrombus are associated with a poor prognosis, and intravenous thrombolysis with rt-PA is associated with a shortened recanalization time during mechanical thrombectomy.

Keywords

• acute cerebral infarction
• mechanical recanalization
• thrombotic components
• prognosis