Thrombus Histology of Basilar Artery Occlusions
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ORIGINAL ARTICLE
Thrombus Histology of Basilar Artery Occlusions Are There Differences to the Anterior Circulation? M. Berndt1 · H. Poppert2,7 · K. Steiger3 · J. Pelisek4,5 · P. Oberdieck6 · C. Maegerlein1 · C. Zimmer1 · S. Wunderlich7 · B. Friedrich1 · T. Boeckh-Behrens1 · B. Ikenberg7 Received: 27 March 2020 / Accepted: 5 September 2020 © The Author(s) 2020
Abstract Background For patients with acute vessel occlusions of the anterior circulation histopathology of retrieved cerebral thrombi has been reported to be associated to stroke etiology. Due to the relatively small incidence of posterior circulation stroke, exclusive histopathologic analyses are missing for this subgroup. The aim of the study was to investigate thrombus histology for patients with basilar artery occlusions and uncover differences to anterior circulation clots with respect to underlying etiology. Methods A total of 59 basilar thrombi were collected during intracranial mechanical recanalization and quantitatively analyzed in terms of their relative fractions of the main constituents, e.g. fibrin/platelets (F/P), red (RBC) and white blood cells (WBC). Data were compared to histopathological analyses of 122 thrombi of the anterior circulation with respect to underlying pathogenesis. Results The composition of basilar thrombi differed significantly to thrombi of the anterior circulation with an overall higher RBC amount (median fraction in % (interquartile range):0.48 (0.37–0.69) vs. 0.37 (0.28–0.50), p < 0.001) and lower F/P count (0.45 (0.21–0.58) vs. 0.57 (0.44–0.66), p < 0.001). Basilar thrombi composition did not differ between the different etiological stroke subgroups. Conclusion The results depict a differing thrombus composition of basilar thrombi in comparison to anterior circulation clots with an overall higher amount of RBC. This may reflect different pathophysiologic processes between anterior and posterior circulation thrombogenesis, e.g. a larger proportion of appositional thrombus growth in the posterior circulation.
Keywords Stroke · Thrombectomy · Histology · Clot
The authors T. Boeckh-Behrens and B. Ikenberg contributed equally to the manuscript. Availability of data and material The raw patient level data are available on reasonable request and after clearance by the local ethics committee. Data Sharing The raw patient level data that support the findings of this study are available from the corresponding author on reasonable request and after clearance by the local ethics committee. M. Berndt
2
Helios Klinikum München West, Munich, Germany
3
Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
4
Department of Vascular and Endovascular Surgery, Klinikum rechts der School of Medicine, Technical University of Munich, Munich, Germany
5
Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
6
Klinikum Neuperlach, Munich, Germany
7
Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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