No Histological Difference between Large Atherosclerotic and Cardiogenic Embolic Thrombus

Area of Science:

• Neurology
• Pathology
• Cardiology

Background:

• Endovascular technology advances enable detailed thrombus histological studies.
• Current secondary stroke prevention strategies (anticoagulant/antiplatelet therapy) are insufficient for some patients experiencing recurrent strokes.
• Histological thrombus analysis can inform personalized secondary prevention strategies.

Purpose of the Study:

• To investigate the histological differences between large artery atherosclerotic and cardiogenic embolic thrombi.
• To guide clinical secondary prevention strategies for these distinct stroke subtypes.

Main Methods:

• Collected thrombus specimens from 54 acute ischemic stroke patients (Dec 2019 - Apr 2021).
• Classified stroke subtypes using the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) criteria.
• Performed hematoxylin-eosin staining and statistical analysis of thrombus components (red blood cells, fibrin/platelets).

Main Results:

• Cardiogenic thrombi: 51.38% red blood cells (RBCs), 48.62% fibrin/platelets.
• Atherosclerotic thrombi: 50.40% RBCs, 49.60% fibrin/platelets.
• No statistically significant difference in the composition of RBCs or fibrin/platelets between cardiogenic and atherosclerotic thrombi (P = 0.89).

Conclusions:

• Histological composition of cardiogenic and atherosclerotic thrombi shows no significant difference.
• Both thrombus types are mixed, containing abundant RBCs, fibrinogen, and platelets.
• Combined anticoagulation and antiplatelet therapy may offer a more effective secondary prevention approach for ischemic stroke.