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Author Spotlight: A Novel Method for Comprehensive Cell Component Analysis of Cerebral Blood Clots
Published on: July 21, 2023
Exploring thrombus composition in cerebral venous thrombosis: the first case report with initial insights and
Ghil Schwarz1, Angelo Cascio Rizzo2, Martina Di Como3
1Department of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. ghilschwarz@gmail.com.
Insights
Endovascular thrombectomy (EVT) for cerebral venous thrombosis (CVT) removed erythrocyte-rich clots. Histologic analysis revealed neutrophil dominance, offering new insights into CVT pathophysiology and treatment strategies.
Area of Science:
- Neurology
- Vascular Medicine
- Thrombosis Research
Background:
- Cerebral venous thrombosis (CVT) can necessitate endovascular thrombectomy (EVT) for patients with deteriorating symptoms despite anticoagulation.
- Understanding thrombus composition in CVT is crucial for elucidating disease mechanisms and developing novel therapeutic approaches.
Observation:
- A patient with massive CVT underwent successful EVT, retrieving two large, reddish clots.
- Histologic examination revealed an erythrocyte-rich thrombus (83.9%) with platelet/fibrin layers (Zahn lines) and significant neutrophil presence (30%), including neutrophil extracellular traps (NETs).
- Rare T- and B-lymphocytes, monocytes/macrophages, hemosiderin, and endothelial cells were noted.
Findings:
- The retrieved CVT thrombus was predominantly composed of erythrocytes and neutrophils.
- Neutrophil extracellular traps (NETs) were present in the thrombus, suggesting a role in CVT pathogenesis.
- The absence of hemosiderin and endothelial cells indicates an acute thrombotic event.
Implications:
- This case provides the first histologic characterization of an EVT-retrieved CVT thrombus.
- Thrombus analysis in CVT can offer critical insights into disease pathophysiology.
- Findings may guide the development of targeted treatment strategies for cerebral venous thrombosis.
Background:
Endovascular thrombectomy (EVT) is a treatment option in patients with a cerebral venous thrombosis (CVT) who deteriorate despite anticoagulant treatment. Assessment of thrombus composition in CVT may provide insights into the pathophysiology of the disease and suggest new therapeutic strategies.
Case Report:
A 47-year-old woman (smoking habit and estradiol/progesterone-releasing intra-uterine device) diagnosed with massive CVT underwent EVT (complete recanalization via aspiration catheter and stentriever) due to acute-onset left-sided weakness and dysarthria despite 72 h of full-dose subcutaneous low-molecular heparin. Two main reddish clots (maximum diameter 15 mm) were retrieved. Microscopic assessment showed an erythrocyte-rich thrombus (83.9% of entire thrombus surface) with layers of platelets/fibrin (lines of Zahn: 13.9% fibrin and 38.5% platelet [CD61+]). The immunological profile was dominated by neutrophils (30% MPO+), with neutrophil extracellular traps (NETs) in 1.9% of thrombus surface. T- (CD3+), B-lymphocytes (CD20+), and monocytes/macrophages (CD68+) were rather rare (2.2%, 0.7%, and 2.0% respectively). We found no evidence (0.0%) of hemosiderin and endothelial cells (CD34+). Full clinical recovery occurred prior to discharge.
Conclusion:
This is the first case report of a CVT with histologic assessment of the thrombus retrieved via EVT. Evaluating thrombi in CVT can provide key insights into disease pathophysiology and guide treatment advancements.
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