Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathology: results of the MR CLEAN Registry

Hund, H.; Boodt, N.; Terreros, N.A.; Taha, A.; Marquering, H.A.; Es, A.C.G.M. van; ... ; MR CLEAN Registry Investigators (2022)

Article / Letter to editor

Objectives Thrombus computed tomography (CT) characteristics might be used to assess histopathologic thrombus composition in patients treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). We aimed to assess the variability in thrombus composition that could be predicted with combined thrombus CT characteristics. Methods Thrombi of patients enrolled in the MR CLEAN Registry between March 2014 and June 2016 were histologically analyzed with hematoxylin-eosin staining and quantified for percentages of red blood cells (RBCs) and fibrin/platelets. We estimated the association between general qualitative characteristics (hyperdense artery sign [HAS], occlusion location, clot burden score [CBS]) and thrombus composition with linear regression, and quantified RBC variability that could be explained with individual and combined characteristics with R-2. For patients with available thin-slice (<= 2.5 mm) imaging, we performed similar analyses for general and quantitative characteristics (HAS, occlusion location, CBS, [relative] thrombus density, thrombus length, perviousness, distance from ICA-terminus). Results In 332 included patients, the presence of HAS (a beta 7.8 [95% CI 3.9-11.7]) and shift towards a more proximal occlusion location (a beta 3.9 [95% CI 0.6-7.1]) were independently associated with increased RBC and decreased fibrin/platelet content. With general characteristics, 12% of RBC variability could be explained; HAS was the strongest predictor. In 94 patients with available thin-slice imaging, 30% of RBC variability could be explained; thrombus density and thrombus length were the strongest predictors. Conclusions Quantitative thrombus CT characteristics on thin-slice admission CT improve prediction of thrombus composition and might be used to further guide clinical decision-making in patients treated with EVT for AIS in the future.

• Ischemic stroke
• Computed tomography
• Thrombus
• Thrombectomy
• Histopathology

• All authors: Hund, H.; Boodt, N.; Terreros, N.A.; Taha, A.; Marquering, H.A.; Es, A.C.G.M. van; Bokkers, R.P.H.; Nijeholt, G.J.L.A.; Majoie, C.B.L.M.; Dippel, D.W.J.; Lingsma, H.F.; Beusekom, H.M.M. van; Lugt, A. van der; MR CLEAN Registry Investigators
• Date: 2022-04-30
• Journal: European Radiology
• Volume: 32
• Issue: 11
• Pages: 7811 - 7823
• DOI: doi:10.1007/s00330-022-08762-y