Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors

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 10x10 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.