Diverse thrombus composition in thrombectomy stroke patients with longer time to recanalization

Mehdi Abbasi, Jorge Arturo Larco, Madalina Oana Mereuta, Yang Liu, Seán Fitzgerald, Daying Dai, Ramanathan Kadirvel, Luis Savastano, David F. Kallmes, Waleed Brinjikji

Research output: Contribution to journalArticlepeer-review


Background and purpose: Delayed time to recanalization is associated with reduced recanalization success of mechanical thrombectomy (MT) and thrombolysis in acute ischemic stroke (AIS). The reasons for this are unclear. We hypothesized that alterations in thrombus structure and composition could be responsible for this. Methods: Retrieved thrombi from AIS patients who underwent MT less than 8 h from symptom onset to groin puncture (SOGP) were evaluated. Patients were divided into early (≤4 h.) vs delayed (> 4 h) groups based SOGP timing. Thrombi were histologically analysed using Martius Scarlett Blue and immunohistochemistry staining for von Willebrand Factor (vWF), anti-citrullinated H3 (H3Cit; NETs [neutrophil extracellular traps] marker). We used inferential statistics including, t-test, artificial neural network (ANN) to interpret the data. Results: A total of 137 thrombi were collected. The overall average percentage of red blood cells (RBC), white blood cells (WBC), platelet, fibrin, H3Cit, and vWF components in thrombi was 45.83%, 3.58%, 22.23%, 28.27%, 19.97% and 16.23% respectively. Delayed group had higher WBCs, (p = 0.02), fibrin (p = 0.02), H3Cit (p = 0.04) and vWF (p = 0.03) thrombus fractions compared to early group. Based on ANN model, the most important factors for predicting the number of passes required for successful recanalization are fibrin and RBC contents of the thrombus followed by vWF and H3Cit contents. Conclusions: Longer time to recanalization was associated with increased WBCs, fibrin, H3Cit and vWF fractions of thrombi reflecting possible in situ maturation of thrombus components. Increased fibrin, NETs and vWF composition may reduce likelihood of revascularization by altering thrombus mechanical properties.

Original languageEnglish (US)
Pages (from-to)99-104
Number of pages6
JournalThrombosis research
StatePublished - Jan 2022


  • Delayed recanalization time
  • Mechanical thrombectomy
  • NETs
  • Thrombus composition
  • vWF

ASJC Scopus subject areas

  • Hematology


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