Thrombotic Pathology is not Correlated with the Prognosis of Endovascular Treatment for Acute Ischemic Stroke.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association(2021)
Abstract
OBJECTIVE:The aim of the present study was to determine whether there is a correlation between thrombotic pathology and prognosis of endovascular treatment (EVT) for acute ischemic stroke (AIS).
METHODS:Thrombi were taken from 58 patients with cerebral ischemic thrombosis who were consecutively selected for EVT for AIS. The collected thrombi then underwent hematoxylin-eosin staining for pathological examinations to determine the red blood cell (RBC) ratio and fibrin/platelet components. The patients were divided into the following three groups according to their proportions of RBCs in thrombi: RBC-rich group (RBC ratio ≥ 70%), mixed group (RBC ratio at 31-69%), and fibrin/platelet-rich group (RBC ratio ≤ 30%). Prognosis was classified into good (0-2 points on modified Rankin scale [mRS] at postoperative 90 days) and poor (3-6 points on mRS at postoperative 90 days). Correlational analysis was performed between thrombotic pathology and prognosis of EVT for AIS.
RESULTS:Among all patients, the distributions were as follows: 18.96% (11/58) patients in the RBC-rich group, 63.79% (37/58) patients in the mixed group, and 17.24% (10/58) patients in the fibrin/platelet-rich group. In addition, 43.10% (25/58) of the patients had good prognosis and 56.90% (33/58) had poor prognosis.There was no statistically significant difference between the good prognosis and the poor prognosis in the RBC-rich group, the mixed group, and the fibrin/platelet-rich group (P=0.713, 0.829, 0.748).Multivariate logistic regression analysis to explored the association between RBC-rich group and good prognosis while adjusting for other baseline prognostic factors (age, ASPECTS, NIHSS score, and PRT and intravenous alteplase-bridging therapy). Compared to the fibrin/platelet-rich group, the odds ratio(OR) of achieving good prognosis was 0.60 (P = 0.592) for the mixed group and OR = 0.74 (P = 0.793) for the RBC-rich group.Notably, age was found to be negatively associated with good prognosis (OR = 0.91, P = 0.013). The ASPECTS score was found to be positively associated with good prognosis (OR = 2.01, P = 0.002). Alteplase bridging was associated with a marginally significant positive association with good prognosis (OR = 4.23, P = 0.083).
CONCLUSIONS:No correlation was found between thrombotic pathology and prognosis of EVT for AIS. Good prognosis after endovascular treatment was associated with low age, high ASPECTS at admission, and alteplase bridging.
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