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Quantitative Morphology of Cerebral Thrombi Related to Intravital Contraction and Clinical Features of Ischemic Stroke

Stroke (1970), 2020-12, Vol.51 (12), p.3640-3650 [Peer Reviewed Journal]

2020 American Heart Association, Inc. ;ISSN: 0039-2499 ;EISSN: 1524-4628 ;DOI: 10.1161/STROKEAHA.120.031559 ;PMID: 33040705

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Title:
Quantitative Morphology of Cerebral Thrombi Related to Intravital Contraction and Clinical Features of Ischemic Stroke
Author: Khismatullin, Rafael R ; Nagaswami, Chandrasekaran ; Shakirova, Asia Z ; Vrtková, Adéla ; Procházka, Václav ; Gumulec, Jaromír ; Mačák, Jiří ; Litvinov, Rustem I ; Weisel, John W
Subjects: Aged ; Blood Platelets - pathology ; Blood Platelets - ultrastructure ; Cell Shape ; Clot Retraction ; Embolic Stroke - pathology ; Embolic Stroke - physiopathology ; Embolic Stroke - therapy ; Erythrocytes - pathology ; Erythrocytes - ultrastructure ; Female ; Fibrin - ultrastructure ; Fibrinolytic Agents - therapeutic use ; Humans ; Inflammation - pathology ; Ischemic Stroke - pathology ; Ischemic Stroke - physiopathology ; Ischemic Stroke - therapy ; Male ; Microscopy, Electron, Scanning ; Severity of Illness Index ; Thrombectomy ; Thrombotic Stroke - pathology ; Thrombotic Stroke - physiopathology ; Thrombotic Stroke - therapy
Is Part Of: Stroke (1970), 2020-12, Vol.51 (12), p.3640-3650
Description: BACKGROUND AND PURPOSE:The purpose was to assess quantitatively and qualitatively the composition and structure of cerebral thrombi and correlate them with the signs of intravital clot contraction (retraction), as well as with etiology, severity, duration, and outcomes of acute ischemic stroke. METHODS:We quantified high-resolution scanning electron micrographs of 41 cerebral thrombi for their detailed cellular and noncellular composition and analyzed histological images for the overall structure with the emphasis on red blood cell compression, fibrin age, and the signs of inflammation. RESULTS:Cerebral thrombi were quite compact and had extremely low porosity. The prevailing cell type was polyhedral compressed erythrocytes (polyhedrocytes) in the core, and fibrin-platelet aggregates were concentrated at the periphery; both findings are indicative of intravital contraction of the thrombi. The content of polyhedrocytes directly correlated with the stroke severity. The prevalence of fibrin bundles was typical for more severe cases, while the content of fibrin sponge prevailed in cases with a more favorable course. The overall platelet content in cerebral thrombi was surprisingly small, while the higher content of platelet aggregates was a marker of stroke severity. Fibrillar types of fibrin prevailed in atherothrombogenic thrombi. Older fibrin prevailed in thrombi from the patients who received thrombolytics, and younger fibrin dominated in cardioembolic thrombi. Alternating layers of erythrocytes and fibrin mixed with platelets were common for thrombi from the patients with more favorable outcomes. Thrombi with a higher number of leukocytes were associated with fatal cases. CONCLUSIONS:Most cerebral thrombi undergo intravital clot contraction (retraction) that may be of underestimated clinical importance. Despite the high variability of the composition and structure of cerebral thrombi, the content of certain types of blood cells and fibrin structures combined with the morphological signs of intravital contraction correlate with the clinical course and outcomes of acute ischemic stroke.
Publisher: United States: American Heart Association, Inc
Language: English
Identifier: ISSN: 0039-2499
EISSN: 1524-4628
DOI: 10.1161/STROKEAHA.120.031559
PMID: 33040705
Source: MEDLINE
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Quantitative Morphology of Cerebral Thrombi Related to Intravital Contraction and Clinical Features of Ischemic Stroke

2020 American Heart Association, Inc. ;ISSN: 0039-2499 ;EISSN: 1524-4628 ;DOI: 10.1161/STROKEAHA.120.031559 ;PMID: 33040705

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