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Original research
Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors
  1. Yuko Kataoka1,2,
  2. Kazutaka Sonoda3,4,
  3. Jun C Takahashi5,6,
  4. Hatsue Ishibashi-Ueda7,8,
  5. Kazunori Toyoda1,
  6. Yusuke Yakushiji2,
  7. Hirofumi Kusaka2,
  8. Masatoshi Koga1
  1. 1Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  2. 2Department of Neurology, Kansai Medical University, Hirakata, Osaka, Japan
  3. 3Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  4. 4Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
  5. 5Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  6. 6Department of Neurosurgery, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan
  7. 7Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  8. 8Department of Pathology, Hokusetsu General Hospital, Takatsuki, Osaka, Japan
  1. Correspondence to Dr Yuko Kataoka, Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; yuko.iwasaki.micro{at}outlook.jp

Abstract

Background The procoagulant state in cancer increases the thrombotic risk, and underlying cancer could affect treatment strategies and outcomes in patients with ischemic stroke. However, the histopathological characteristics of retrieved thrombi in patients with cancer have not been well studied. This study aimed to assess the histopathological difference between thrombi in patients with and without cancer.

Methods We studied consecutive patients with acute major cerebral artery occlusion who were treated with endovascular therapy between October 2010 and December 2016 in our single-center registry. The retrieved thrombi were histopathologically investigated with hematoxylin and eosin and Masson’s trichrome staining. The organization and proportions of erythrocyte and fibrin/platelet components were studied using a lattice composed of 10×10 squares.

Results Of the 180 patients studied, 17 (8 women, age 76.5±11.5 years) had cancer and 163 (69 women, age 74.1±11.2 years) did not. Those with cancer had a higher proportion of fibrin/platelets (56.6±27.4% vs 40.1±23.9%, p=0.008), a smaller proportion of erythrocytes (42.1±28.3% vs 57.5±25.1%, p=0.019), and higher serum D-dimer levels (5.9±8.2 vs 2.4±4.3 mg/dL, p=0.005) compared with the non-cancer cases. Receiver operating characteristic curve analysis showed the cut-off ratio of fibrin/platelet components related to cancer was 55.7% with a sensitivity of 74.8%, specificity 58.8% and area under the curve (AUC) value of 0.67 (95% CI 0.53 to 0.81), and the cut-off ratio of erythrocyte components was 44.7% with a sensitivity of 71.2%, specificity 58.9% and AUC value of 0.66 (95% CI 0.51 to 0.80).

Conclusions Thromboemboli of major cerebral arteries in patients with cancer were mainly composed of fibrin/platelet-rich components.

  • stroke
  • tumor
  • thrombectomy
  • embolic

Data availability statement

No data are available. Not applicable.

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Data availability statement

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Footnotes

  • Contributors Study conception and design: YK and KS. Drafting the article: YK. Revising the manuscript critically for important intellectual content: KS and MK. Acquisition of the data: all authors. Technical/material support: KS, JCT, and HI-U. Analysis and interpretation of the data: all authors. Study supervision: KT, YY, HK, and MK. Final approval of the version to be published: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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