Quantitative histopathological analysis of thrombi retrieved by mechanical thrombectomy and their association with stroke aetiology - Original research

Q: What is the study’s primary goal?

Quantify thrombus composition in patients with large vessel occlusive ischemic stroke and evaluate how thrombus composition relates to stroke aetiology.

Q: Which thrombus components were measured?

Erythrocytes, leucocytes, and F+P (fibrin+platelet) proportions were assessed on H&E-stained sections, while CD3+ T cells and neutrophil extracellular traps (NETs) were quantified using immunohistochemistry.

Q: How did thrombus composition differ between cardioembolic and large artery atherosclerosis strokes?

F+P composition was significantly higher and erythrocyte proportions significantly lower in cardioembolic thrombi compared with large artery atherosclerosis thrombi.

Sep 29, 2026

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Approximately 25% of acute large vessel occlusive ischemic strokes have an unknown thrombotic source, requiring etiologic clarification to guide prevention. This study quantified thrombus composition in 132 acute ischemic stroke patients after mechanical thrombectomy and assessed erythrocyte, leucocyte, and fibrin+platelet proportions, plus CD3+ T cells and NETs. Composition differed by stroke subtype, with cardioembolic clots showing higher F+P and lower erythrocytes. Thrombus heterogeneity suggested a potential biomarker role for determining stroke aetiology.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background and purpose

Methods

Results

Conclusion

Introduction

What is already known on this topic

What this study adds

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Open access Original research To cite: Jiang Z, Huang J, Hu S, et al. Quantitative histopathological analysis of thrombi retrieved by mechanical thrombectomy and their association with stroke aetiology. Stroke & Vascular Neurology 2025;0 . doi:10 . 1136/ svn-2024-003543 ► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[svn-2024-003543](svn-2024-003543) ) . ZJ and JH contributed equally. Received 14 July 2024 Accepted 12 January 2025 © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. 1Neurology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China 2Department of Sports Medicine, The Xiangya Hospital, Central South University, Changsha, China 3Department of Neurology, The Fourth Hospital of Changsha, Changsha, China 4Department of Neurology, The Chengdu First People's Hospital, Chengdu, China Correspondence to Yi Yuan; [docyuan@163.com](docyuan@163.com) Quantitative histopathological analysis of thrombi retrieved by mechanical thrombectomy and their association with stroke aetiology Zhiyi Jiang,1,2 Juan Huang ,1 Shuntong Hu ,1 Ruping Xiang,3 Longfeng Ran,4 Yiwei Chen,1 Dujie Xie,1 Panyao Long,1 Xiaobo Li,1 Yi Yuan1 ABSTRACT Background and purpose Approximately 25% of acute large vessel occlusive (LVO) ischaemic strokes are of unknown thrombotic origin, and there is a need to establish the aetiology to guide subsequent preventative measures. The aim of this study was to quantify thrombus composition in patients with LVO and explore associations between thrombus composition and stroke aetiology. Methods Thrombi were extracted from 132 patients with acute ischaemic stroke. Erythrocytes, leucocytesand F+P (fibrin+platelet) proportions were assessed in tissue sections stained with H&E, while CD3+ T cells and neutrophil extracellular traps (NETs) were quantified in immunohistochemistry-stained sections. Thrombus components, clinical parameters and interventional variables were compared between different stroke subtypes defined by Trial of ORG 10172 in Acute Stroke Treatment criteria. Results F+P composition was significantly higher (p<0 .001) and erythrocyte proportions were significantly lower (p<0 .001) in cardioembolic thrombi than in large artery atherosclerosis thrombi. The composition of thrombi from undetermined aetiology strokes resembled that from cardioembolic strokes. CD3+ T cell and NET proportions were not significantly different between stroke subtypes. CD3+ density per unit area was associated with theocclusive site, being significantly higher in the anterior circulation than the posterior circulation (p=0 .004) . Cardioembolic strokes were more common in the anterior circulation than large artery atherosclerosis strokes (p=0 .002) . Recanalisation time was significantly longer for large artery atherosclerosis emboli than for cardioembolicemboli (p=0 .032) . Conclusion There is significant heterogeneity in thrombus composition among different stroke subtypes. The quantitative assessment of thrombus composition maybe a useful biomarker of stroke aetiology, and strokes of undetermined aetiology may be more likely to have acardioembolic origin. INTRODUCTION Cerebrovascular diseases are a major cause of disability, morbidity and death worldwide,1 especially through infarction caused by large cerebral vessel occlusion (LVO) . Fortunately, advances in mechanical thrombectomy have WHAT IS ALREADY KNOWN ON THIS TOPIC | ⇒ There have been several histopathological studies of intracranial thrombi to establish associations between clot composition and clinicopathological outcomes, but the data are conflicting.
WHAT THIS STUDY ADDS | | --- | | ⇒ This is an article examining the relationship between thrombus composition and other clinica

FAQs

What is the study’s primary goal?

Quantify thrombus composition in patients with large vessel occlusive ischemic stroke and evaluate how thrombus composition relates to stroke aetiology.

Which thrombus components were measured?

Erythrocytes, leucocytes, and F+P (fibrin+platelet) proportions were assessed on H&E-stained sections, while CD3+ T cells and neutrophil extracellular traps (NETs) were quantified using immunohistochemistry.

How did thrombus composition differ between cardioembolic and large artery atherosclerosis strokes?

F+P composition was significantly higher and erythrocyte proportions significantly lower in cardioembolic thrombi compared with large artery atherosclerosis thrombi.

Sep 29, 2026

Upload by CatatanPagi