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Ischemic stroke
Original research
The immunologic phenotype of thrombi is associated with future vascular events after cerebral infarction
  1. Wookjin Yang1,
  2. Soon Auck Hong2,
  3. Jeong-Min Kim1,
  4. Hae-Bong Jeong3,
  5. Taek-Kyun Nam4,
  6. Hyun Ho Choi4,
  7. Suh Min Kim5,
  8. Kwang-Yeol Park3,
  9. Hye Ryoun Kim6
  1. 1 Department of Neurology, Seoul National University Hospital, Seoul, Korea
  2. 2 Department of Pathology, Chung-Ang University Hospital, Seoul, Korea
  3. 3 Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
  4. 4 Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
  5. 5 Department of Surgery, Chung-Ang University College of Medicine and Graduate School of Medicine, Seoul, Korea
  6. 6 Department of Laboratory Medicine, Chung-Ang University Hospital, Seoul, Korea
  1. Correspondence to Dr Jeong-Min Kim, Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; bellokim1{at}gmail.com; Dr Kwang-Yeol Park, Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul 06973, Korea; kwangyeol.park{at}gmail.com

Abstract

Background Thrombi retrieved from patients with acute ischemic stroke may contain prognostic information.

Objective To investigate the relationship between the immunologic phenotype of thrombi and future vascular events in patients with a stroke.

Methods This study included patients with acute ischemic stroke who underwent endovascular thrombectomy at Chung-Ang University Hospital in Seoul, Korea, between February 2017 and January 2020. Laboratory and histological variables were compared between patients with and without recurrent vascular events (RVEs). Kaplan–Meier analysis followed by the Cox proportional hazards model was used to identify factors related to RVE. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of the immunologic score by combining immunohistochemical phenotypes to predict RVE.

Results A total of 46 patients were included in the study with 13 RVEs (mean±SD age, 72.8±11.3 years; 26 (56.5%) men). Thrombi with a lower percentage of programmed death ligand-1 expression (HR=11.64; 95% CI 1.60 to 84.82) and a higher number of citrullinated histone H3 positive cells (HR=4.19; 95% CI 0.81 to 21.75) were associated with RVE. The presence of high-mobility group box 1 positive cell was associated with reduced risk of RVE, but the association was lost after adjustment for stroke severity. The immunologic score, which consists of the three immunohistochemical phenotypes, showed good performance in predicting RVE (area under the ROC curve, 0.858; 95% CI 0.758 to 0.958).

Conclusions The immunological phenotype of thrombi could provide prognostic information after stroke.

  • stroke
  • inflammation
  • thrombectomy

Data availability statement

Data are available upon reasonable request. The data supporting the findings of this study are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/jnis-2023-020155

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    Data availability statement

    Data are available upon reasonable request. The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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    Footnotes

    • WY and SAH contributed equally.

    • Contributors Conception and design of the study: WY, SAH, J-MK, H-BJ, T-KN, HC, SMK, K-YP, and HRK. Acquisition and analysis of data: WY, SAH, J-MK, H-BJ, T-KN, HC, SMK, K-YP, and HRK. Manuscript drafting: WY, SAH, and J-MK. Critical manuscript revision: WY, SAH, J-MK, H-BJ, T-KN, HC, SMK, K-YP, and HRK. Full responsibility for the work, final approval of the version to be published, agreement to be accountable for all aspects of the work: J-MK. and K-YP.

    • Funding This study was supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education (NRF-2022R1A2C2007064).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.