title: The Impact of Histological Clot Composition in Embolic Stroke.
abstract: OBJECTIVE
  Thrombus composition has been suggested to have a decisive impact on the outcome of patients treated by mechanical thrombectomy because of embolic stroke. The recent development of stent retrievers allows collection and, hence, histopathological analysis of fresh thrombus material. Against this background, the aim of this prospective study was to assess the impact of thrombus composition on mechanical recanalization, clinical outcome and stroke etiology.
  
  
  METHODS
  Thirty-four patients suffering from acute ischemic stroke due to occlusion of the distal internal carotid artery/carotid-T, anterior cerebral artery, or middle cerebral arteries were mechanically recanalized, and thrombus material was obtained. Histological thrombus composition was compared with imaging, clinical, and neurointerventional data.
  
  
  RESULTS
  The main findings were that a higher percentage of white blood cells (WBCs) in the thrombus was associated with (i) cardioembolic etiology, (ii) extended mechanical recanalization time, and (iii) less favorable recanalization (Thrombolysis in Cerebral Infarction score) and clinical outcome (National Institute of Health Stroke Scale).
  
  
  CONCLUSIONS
  Our results suggest that thrombi with a high WBC fraction are related to more organized thrombi of cardioembolic origin associated with less favorable recanalization and clinical outcome in acute ischemic anterior circulation stroke. WBC-mediated immunological and coagulatory processes may play a key role in thrombus formation and pathogenesis of stroke warranting further investigation.
authors.affiliation: Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. boeckh-behrens@tum.de.
authors.forename: T
authors.initials: T
authors.lastname: Boeckh-Behrens
authors.affiliation: Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schubert
authors.affiliation: Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Förschler
authors.affiliation: Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Prothmann
authors.affiliation: Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Kreiser
authors.affiliation: Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: Department of Experimental Cardiology, German Heart Centre Munich, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Riegger
authors.affiliation: Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Bauer
authors.affiliation: Department of Pathology, German Research Centre for Environmental Health, Munich, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Neff
authors.affiliation: Institute of Medical Statistics and Epidemiology, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Kehl
authors.affiliation: Clinic of Vascular and Endovascular Surgery, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Pelisek
authors.affiliation: Department of Neurology, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Schirmer
authors.affiliation: Department of Neurology, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Mehr
authors.affiliation: Department of Neurology, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Poppert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D007958:Leukocyte Count; D007962:Leukocytes / Q000473:pathology*; D008297:Male; D061185:Mechanical Thrombolysis; D008875:Middle Aged; D020521:Stroke / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D013927:Thrombosis / Q000473:pathology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Histopathology; Mechanical recanalization; Stroke; Thrombus