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Ischemic stroke
Original research
High fibrin and platelet clot predicts stroke recurrence or mortality after thrombectomy in patients with active cancer
  1. Chuan-Hsiu Fu1,
  2. Chih-Hao Chen2,
  3. Yen-Heng Lin3,
  4. Chung-Wei Lee3,
  5. Li-Kai Tsai2,
  6. Sung-Chun Tang2,
  7. Chia-Tung Shun4,5,
  8. Jiann-Shing Jeng2
    1. 1Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
    2. 2Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
    3. 3Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
    4. 4Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
    5. 5Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
    1. Correspondence to Dr Sung-Chun Tang; sctang{at}ntuh.gov.tw

    Abstract

    Background Fibrin and platelet (FP)-rich clots have been shown to be associated with cancer-related stroke. This study aims to investigate the prognostic role of thrombus composition in clinical outcomes among cancer patients who experienced stroke and received endovascular thrombectomy (EVT).

    Methods We included acute ischemic stroke patients who underwent EVT between March 2015 and November 2021. These patients were categorized into three groups: those with active cancer, those with non-active cancer, and those without cancer. The percentages of FP in clots were quantified under hematoxylin and eosin staining. The primary outcome was defined as any stroke recurrence or mortality within 90 days following the index stroke event.

    Results A total of 420 patients with retrieved clots were included in the study. This cohort comprised 50 patients with active cancer, 23 patients with non-active cancer, and 347 patients without cancer. The percentage of FP was significantly higher in thrombi retrieved from patients with active cancer compared with the other two groups. Patients in the active cancer group exhibited a higher rate of the primary outcome compared with the other groups. After adjusting for clinical variables, a higher percentage of FP in thrombi remained significantly associated with the primary outcome in the active cancer group (adjusted odds ratio (aOR) =1.03 (1.00–1.06), P=0.028), but not in the other two groups.

    Conclusion Among stroke patients receiving EVT, thrombi with a higher percentage of FP not only identify individuals with active cancer but also predict stroke recurrence or mortality within 90 days.

    • Stroke
    • Thrombectomy

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    https://doi.org/10.1136/jnis-2024-022033

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      Data availability statement

      All data relevant to the study are included in the article or uploaded as supplementary information.

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      Footnotes

      • Contributors C-HF, C-HC and S-CT screened the literature and reviewed the study proposal together with C-TS. Y-HL, C-WL and other colleagues from the Department of Radiology contributed to thrombus collection. C-HF, C-TS and H-CW (non-author contributor) conducted the histology staining and analysis of thrombus composition. C-HF wrote the first draft of the manuscript with help from C-HC and S-CT in revising the manuscript and assisting in statistical analyses. All the other co-authors contributed to the critical revision of the manuscript. C-HF is responsible for the overall content as the guarantor.

      • Funding The study funding was supported by grants from the National Taiwan University Hospital: NTUH 109-004661.

      • 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.