Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank
Authors: Hund Hajo M. , Boodt Nikki , Hansen Daniel , Haffmans Willem A. , Lycklama à Nijeholt Geert J. , Hofmeijer Jeannette , Dippel Diederik W. J. , van der Lugt Aad , van Es Adriaan C. G. M. , van Beusekom Heleen M. M. ,   on behalf of the MR CLEAN Registry Investigators, Majoie Charles B. L. M. , Roos Yvo B. W. E. M. , van Oostenbrugge Robert J. , van Zwam Wim H. , Boiten Jelis , Vos Jan Albert , Jansen Ivo G. H. , Mulder Maxim J. H. L. , Goldhoorn Robert- Jan B. , Compagne Kars C. J. , Kappelhof Manon , Brouwer Josje , den Hartog Sanne J. , Hinsenveld Wouter H. , Roozenbeek Bob , Emmer Bart J. , Coutinho Jonathan M. , Schonewille Wouter J. , Wermer Marieke J. H. , van Walderveen Marianne A. A. , Staals Julie , Martens Jasper M. , de Bruijn Sebastiaan F. , van Dijk Lukas C. , van der Worp H. Bart , Lo Rob H. , van Dijk Ewoud J. , Boogaarts Hieronymus D. , de Vries J. , de Kort Paul L. M. , van Tuijl Julia , Peluso Jo P. , Fransen Puck , van den Berg Jan S. P. , van Hasselt Boudewijn A. A. M. , Aerden Leo A. M. , Dallinga René J. , Uyttenboogaart Maarten , Eschgi Omid , Bokkers Reinoud P. H. , Schreuder Tobien H. C. M. L. , Heijboer Roel J. J. , Keizer Koos , Yo Lonneke S. F. , den Hertog Heleen M. , Bulut Tomas , Brouwers Paul J. A. M. , Sprengers Marieke E. S. , Jenniskens Sjoerd F. M. , van den Berg René , Yoo Albert J. , Beenen Ludo F. M. , Postma Alida A. , Roosendaal Stefan D. , van der Kallen Bas F. W. , van den Wijngaard Ido R. , Bot Joost , van Doormaal Pieter-Jan , Meijer Anton , Ghariq Elyas , van Proosdij Marc P. , Krietemeijer G. Menno , Dinkelaar Wouter , Appelman Auke P. A. , Hammer Bas , Pegge Sjoert , van der Hoorn Anouk , Vinke Saman , Flach H. Zwenneke , Lingsma Hester F. , el Ghannouti Naziha , Sterrenberg Martin , Pellikaan Wilma , Sprengers Rita , Elfrink Marjan , Simons Michelle , Vossers Marjolein , de Meris Joke , Vermeulen Tamara , Geerlings Annet , van Vemde Gina , Simons Tiny , Messchendorp Gert , Nicolaij Nynke , Bongenaar Hester , Bodde Karin , Kleijn Sandra , Lodico Jasmijn , Droste Hanneke , Wollaert Maureen , Verheesen Sabrina , Jeurrissen D. , Bos Erna , Drabbe Yvonne , Sandiman Michelle , Aaldering Nicoline , Zweedijk Berber , Vervoort Jocova , Ponjee Eva , Romviel Sharon , Kanselaar Karin , Barning Denn , Venema Esmee , Chalos Vicky , Geuskens Ralph R. , van Straaten Tim , Ergezen Saliha , Harmsma Roger R. M. , Muijres Daan , de Jong Anouk , Berkhemer Olvert A. , Boers Anna M. M. , Huguet J. , Groot P. F. C. , Mens Marieke A. , van Kranendonk Katinka R. , Treurniet Kilian M. , Tolhuisen Manon L. , Alves Heitor , Weterings Annick J. , Kirkels Eleonora L.F. , Voogd Eva J. H. F. , Schupp Lieve M. , Collette Sabine L. , Groot Adrien E. D. , LeCouffe Natalie E. , Konduri Praneeta R. , Prasetya Haryadi , Arrarte-Terreros Nerea , Ramos Lucas A. 
Published: January 2023

Abstract
Purpose

The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice.

Methods

The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification.

Results
The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00–1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00–1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar.

Conclusion
Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.