Clot Composition and Ischemic Stroke Etiology: A Contemporary Narrative Review

Area of Science:

• Neurology
• Pathology
• Biochemistry

Background:

• Acute ischemic stroke (AIS) is a major cause of death and disability worldwide.
• Understanding stroke etiology is crucial for effective secondary prevention.
• Mechanical thrombectomy (MT) provides retrieved clots for analysis, advancing clot composition studies.

Purpose of the Study:

• To review the current understanding of stroke etiologies and their relationship to clot composition.
• To explore how clot analysis, including histology and multiomics, can inform stroke etiology prediction.
• To highlight the potential of next-generation sequencing techniques in diagnosing and managing AIS.

Main Methods:

• Review of existing literature on clot composition in AIS.
• Analysis of histological and molecular features of clots retrieved during MT.
• Exploration of proteomic and transcriptomic data from clot analyses.

Main Results:

• Differences exist between large-artery atherosclerosis (LAA) and cardioembolic (CE) clots, but clinical prediction remains challenging.
• Multiomic sequencing offers potential for detailed clot pathology understanding.
• Histological and molecular analyses provide insights into stroke etiology.

Conclusions:

• Clot composition analysis is a growing field with significant potential for understanding AIS.
• Next-generation multiomic techniques can provide the granularity needed for clinical diagnosis and management of stroke.
• Further research integrating multiomic data may improve secondary stroke prevention.