“Red Cardiac versus White Atherosclerotic Thromboemboli in Acute Ischemic Stroke”: Challenging the Concept via a Large-scale, Detailed Multi-parametric Histological Analysis - ISTH Congress Abstracts

“Red Cardiac versus White Atherosclerotic Thromboemboli in Acute Ischemic Stroke”: Challenging the Concept via a Large-scale, Detailed Multi-parametric Histological Analysis

S. Staessens¹, O. François², E. Boulleaux³, D. Corseaux³, L. Desender¹, A. Vandenbulcke¹, J. de Boer⁴, C. Vens⁴, A.-S. De Sloovere², T. Dewaele², P. Vanacker^5,6,7, S. Susen^3,8, K. Vanhoorelbeke¹, C. Cordonnier⁹, T. Andersson^2,10, S.F. De Meyer¹

¹Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium, ²Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium, ³University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France, ⁴Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium, ⁵Department of Neurology, AZ Groeninge, Kortrijk, Belgium, ⁶Department of Neurology, University Hospitals Antwerp, Antwerp, Belgium, ⁷Department of Translational Neuroscience, University of Antwerp, Antwerp, Belgium, ⁸Department of Hematology Transfusion, Centre Hospitalier Universitaire de Lille, Lille, France, ⁹INSERM U1172 - Lille NeuroScience & Cognition (LilNCog), University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France, ¹⁰Departments of Neuroradiology, Karolinska University Hospital, and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Abstract Number: PB0016

Meeting: ISTH 2021 Congress

Theme: Arterial Thromboembolism » Cerebrovascular Disorders

Background: In ischemic stroke, thromboemboli are often described as white (platelet-rich) or red (red blood cell (RBC)-rich) when having an atherosclerotic or cardiac origin respectively. Secondary stroke prevention is mainly based on antiplatelet therapy for atherosclerotic etiologies and anticoagulation for cardioembolic etiologies. Yet, despite prevention, up to 25% of patients experience a recurrent stroke within the first 5 years after the initial event. Better understanding of thromboembolus composition can improve our understanding of underlying pathophysiologies and help in designing improved prevention strategies.

Aims: To perform a large-sample-study including multi-parameter quantitative histological analysis to investigate differences in composition of thromboemboli of different etiologies.

Methods: Thromboemboli (n=501) were collected from thrombectomy-treated ischemic stroke patients at Groeninge Hospital (Kortrijk, Belgium) and CHU Lille (Lille, France). Stroke etiology was categorized according to the TOAST classification. Quantitative histological analysis was performed for the amount RBCs, platelets, fibrin, von Willebrand factor (VWF), leukocytes, citrullinated histone H3 (H3Cit) and extracellular (ex)DNA.

Results: Compared to large artery atherosclerotic (LAA) thromboemboli (Figure 1), cardioembolic (CE) thromboemboli contained significantly less RBCs (51.6%+/-19.0% vs. 37.9%+/-19.0%) and significantly more platelets (29.0%+/-14.0% vs. 36.9%+/-18.2%), fibrin (24.7%+/-13.0% vs. 34.6%+/-16.9%), leukocytes (14.8%+/-10.6% vs. 19.7%+/-14.1%) and exDNA (74% vs. 88% scoring moderate/high). VWF (35.5%+/-16.6% vs. 33.4%+/-15.4%) and H3Cit (6.6%+/-7.6% vs. 5.4+/-6.8%) content were not different in CE/LAA thromboemboli respectively. Intriguingly, cryptogenic thromboemboli contained relatively low amounts of RBCs and high amounts of platelets (Figure 1), similar to CE thromboemboli. Notwithstanding these population differences, a typical CE or LAA thromboembolus cannot be defined given the observed heterogeneity in RBC/platelets.

Histological comparison (RBCs and platelets) of CE, LAA and cryptogenic thromboemboli.

Conclusions: In contrast to current concepts of ‘white’ atherosclerotic and ‘red’ cardiac thrombi, CE thromboemboli are more platelet-rich compared to RBC-rich LAA thromboemboli, with a heterogenous RBC/platelet thrombus profile. Such data could hint at combining antiplatelet with anticoagulation therapy in prevention of stroke, as was recently shown to be beneficial in the COMPASS-trial.

To cite this abstract in AMA style:

Staessens S, François O, Boulleaux E, Corseaux D, Desender L, Vandenbulcke A, de Boer J, Vens C, De Sloovere A-, Dewaele T, Vanacker P, Susen S, Vanhoorelbeke K, Cordonnier C, Andersson T, De Meyer SF. “Red Cardiac versus White Atherosclerotic Thromboemboli in Acute Ischemic Stroke”: Challenging the Concept via a Large-scale, Detailed Multi-parametric Histological Analysis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/red-cardiac-versus-white-atherosclerotic-thromboemboli-in-acute-ischemic-stroke-challenging-the-concept-via-a-large-scale-detailed-multi-parametric-histological-analysis/. Accessed November 29, 2023.

« Back to ISTH 2021 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/red-cardiac-versus-white-atherosclerotic-thromboemboli-in-acute-ischemic-stroke-challenging-the-concept-via-a-large-scale-detailed-multi-parametric-histological-analysis/