A Relevant Study Between The Pathology Feature And Etiology Of Acute Ischemic Stroke With Intracranial Large Vessel Occlusion

Background and PurposeA series of large randomized controlled clinical trials have confirmed the safety and effectiveness of endovascular therapy in the treatment of acute large-vessel occlusion,which provides the possibility of obtaining thrombus and perform histopathologic examination of thrombus.Only few studies have been conducted on this topic and shown that the composition,length and physical characteristics of thrombus,and the relationship between them and etiology and endovascular treatment,but there is still lack of study in this field in China.The purpose of this study was to explore the pathological features of acute intracranial large vessel occlusion,and to identify the etiology of SUE,in order to guide the secondary prevention of stroke the recurrence rate.MethodsThe specimens of thrombosis and clinical and imaging data of AIS patients who were treated by EVT in the Advanced Stroke Center of Henan People’s Hospital from December 2018 to January 2021 were prospectively collected and analyzed.All specimens were stained by Hematoxylin and eosin,scanned by histopathological scanner,Pathology experts using pathological Imaging analysis software(Motic Images Plus 3.0,Xiamen)for samples to analyze the red blood cells(RBC),Fibrin/platelet and white blood cells(WBC)component,and observed the difference under optical microscope.Interobserver agreement for the clinical etiology and specific signs was assessed by Kappa coefficient.The data were statistically analyzed by t-test,Chi-square test,one-way ANOVA,Kruskal-Wallis and Wilcoxon test.ResultsA total of 102 AIS patients of intracranial thrombus were collected for pathological specimen and included in the analysis.The etiology of ICAD was 32cases(31.4%)(19 cases of AT-1,13 cases of AT-2),CE was 59 cases(57.8%),SUE was10 cases(9.8%),and SOE was 1case(1%).Twenty-six patients(25.5%)received bridging therapy.Ninety-three patients(91.2%)were successful recanalization(TICI≥2b grade).Perioperative complications occurred in 22 cases(21.6%).Sixty-two patients(60.8%)achieved good outcome(m RS≤2).Eighteen patients(17.6%)died in90 days after operation.The main histological components of thrombus are red blood cell,fibrin/platelet and white blood cell.Most of the thrombus types were traditional mixed thrombus.The component analysis of the HE stained thrombus specimens showed that the percentages of components contained in the thrombus of different stroke etiology types were not exactly the same.Compared with ICAD thrombus,the CE and SUE thrombus had higher fibrin/platelet content and lower RBC content(P < 0.001).We classified the thrombosis according to RBC content,and found that poor erythrocytes were found only in non-ICAD thrombosis,while extensive erythrocytes was found only in ICAD thrombosis.Compared with ICAD thrombosis,there was a higher proportion of white thrombosis and a lower proportion of red thrombosis in CE thrombosis(P=0.003),while mixed thrombosis showed no significant difference among different etiologies(P=0.450).According to the characteristics of microscopic,"Rouge sign" and "leopard-print sign" were found more frequently in CE than in ICAD,although the difference was not statistically significant(P=0.561 and P=0.071).The presence of vascular endothelial cells in thrombus specimens was found in 2 patients(2.1%)due to ICAD.No cholesterol crystal and calcification were found in all specimens.Conclusions1.Quantitative evaluation and microscopic characteristic of thrombus histological components may help to distinguish between different stroke causes.Our study can suggest poor erythrocytes,extensive erythrocytes and Leopard-print sign have high specificity in the diagnosis of CE and ICAD thrombosis,Rouge sign have specificity for the diagnosis of CE thrombosis.2.Compared with ICAD,CE contained a higher proportion of white thrombosis,a higher content of fibrin/platelet and a lower erythrocytes content.While the ICAD thrombus contains a higher proportion of red thrombus.3.Our findings support the notion of the majority of cryptogenic strokes are cardioembolic.