Background and purpose There has been growing interest in the imaging and histopathology of retrieved thrombi after the introduction of mechanical thrombectomy for the treatment of acute ischemic stroke. We conducted a systematic review and meta-analysis of imaging and histological characteristics of thrombi in acute ischemic stroke.
Materials and methods We identified all studies published between January 2005 and December 2015 that reported findings related to the histological and/or imaging characteristics of thrombi in patients with acute ischemic stroke secondary to large vessel occlusion. The five outcomes examined in this study were 1) the association between histological composition of thrombi and stroke etiology, 2) the association between thrombi histological composition and angiographic outcomes, 3) the association between imaging and histological characteristics of thrombi in stroke, 4) the association between imaging characteristics of thrombi and angiographic outcomes and 5) the association between imaging characteristics of thrombi and stroke etiology.
Results There was no significant difference in the proportion of RBC rich thrombi between cardioembolic and large artery atherosclerosis etiologies (OR = 1.62, 95% CI = 0.1–28.0, P = 0.63). Patients with hyperdense artery sign had a higher odds of having RBC rich thrombi than those without a hyperdense artery sign on CT (OR = 9.0, 95% CI = 2.6–31.2, P < 0.01). Patients with a good angiographic outcome had a mean HU of 53.0 compared to a mean HU of 47.3 for patients with a poor angiographic outcome (MSD = 5.6, 95% CI = 1.1–10.0, P = 0.02). There was no association between imaging characteristics and stroke etiology (OR = 1.13, 95% CI = 0.32–4.00, P = 0.85).
Conclusions Hyperdense artery sign is associated with RBC rich thrombi and improved recanalization rates. Further research is needed to determine the association between thrombi composition and stroke etiology as well as revascularization outcomes.
Disclosures W. Brinjikji: None. S. Duffy: 5; C; Neuravi LTD. D. Kallmes: None.
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