Thrombus composition and aetiology
| Ref. (year) | No of patients | % of patients w.r.t aetiology | Staining technique | Main findings |
| Marder et al
7
2006 | 25 | LAA:16 CE:64 ODE:12 UDE:8 | H&E | Similar histological components in CE and LAA |
| Ogata et al
20
2008 | 142 | LAA:12 CE:75 SVO:1 ODE:9 UDE:3 | H&E, Masson’s trichrome, Mallory’s phosphotungstic acid haematoxylin | Most LAA thrombi are fibrin and platelet rich at plaque site and become fibrin and RBC rich while occluding brain arteries CE strokes have RBC rich thrombi |
| Niesten et al
19
2014 | 22 | LAA:36 CE:27 ODE:14 UDE:23 | H&E, Mallory’s phosphotungstic acid- haematoxylin (fibrin) IHC: glycophorin A (RBCs) and CD31 (platelets) | LAA thrombi are RBC rich No differences in platelets and fibrin content between stroke subtypes |
| Boeckh-Behrens et al
9
2014 | 34 | LAA:9 CE:47 ODE:18 UDE:26 | H&E, Elastica van Gieson staining | Higher percentage of WBCs in the thrombus indicates organised thrombi of CE origin |
| Kim et al
35
2015 | 37 | LAA:22 CE:59 UDE:19 | H&E, IHC: CD61(platelet glycoprotein IIIa) | CE thrombi are RBC rich and have lower fibrin content compared with LAA thrombi |
| Simons et al
23
2015 | 40 | CE: 53 | H&E IHC:CD34 | Comparatively higher RBC content in CE thrombi No significant association between CE stroke and thrombus composition |
| Ahn et al
15
2016 | 36 | LAA: 22 CE: 61 UDE: 17 | H&E, MSB IHC: CD42b (platelet glycoprotein Ib) | LAA thrombi were RBC rich and CE thrombi were fibrin rich with platelets clustered within the rich fibrin UDE thrombi (5/6) had histologic features and composition like CE thrombi |
| Boeckh-Behrens et al
8
2016 | 137 | LAA:16 CE:49 ODE:8 UDE:27 | H&E | CE thrombi had higher proportions of fibrin/platelets, less erythrocytes, and more leucocytes than noncardioembolic thrombi UDE strokes had thrombus histology and interventional and clinical outcome parameters similar to CE strokes |
| Dargazanli et al
36
2016 | 54 | LAA:19 CE:46 ODE:24 UDE:11 | H&E, IHC: CD3 (T cells) | High CD3 +T cells count associated with LAA thrombi |
| Schuhmann et al
12
2016 | 37 | LAA: 37 CE:51 UDE:12 | H&E, MSB IHC: CD4 (T cells), CD68 (monocytes) and vWF | Stroke subtype and clinical outcome had no association with immune cell or platelet % or distribution in thrombi RBC rich clots had higher T cells and monocytes |
| Sporns et al
32
2017 | 187 | LAA:19 CE:41 ODE:6 UDE:34 | H&E, Elastica van Gieson, Prussian blue IHC: CD3, CD20, and CD68/KiM1P | CE thrombi are fibrin/platelet rich with more WBCs than non CE thrombi (LAA+ODE) Cryptogenic strokes and CE strokes showed similar thrombus histology The IHC parameters showed no noticeable differences between stroke subtypes |
| Maekawa et al
33
2018 | 43 | LAA: 12 CE: 70 ODE: 2 UDE: 16 | H&E | RBC rich thrombi are associated with non CE aetiology |
| Berndt et al
57
2018 | 133 | LAA: 12 CE: 53 ODE: 2 UDE: 33 | H&E (NCCT and CTA for clot perviousness) | Pervious thrombi are fibrin/platelet rich. Pervious thrombi were significantly associated with CE compared with non-CE thrombi |
| Shin et al
31
2018 | 37 | LAA:19 CE:59 UDE:22 | H&E | RBC-rich clots associated with CE stroke aetiology Fibrin/platelet rich thrombi were more frequent in LAA and undetermined subtypes whereas mixed type was more frequent in CE patients |
| Fitzgerald et al
34
2019 | 105 | LAA:19 CE:50 ODE:11 UDE:20 | H&E, MSB | Platelet-rich clots and % of platelet content significantly higher in LAA than CE thrombi No correlation between stroke aetiology and the other major thrombus components |
| Staessens et al
5
2020 | 177 thrombi | NA | H&E, MSB, Feulgen’s reaction (DNA staining) IHC and IFC: vWF, platelets (GPIbα), fibrin, leukocytes (CD45), RBCs (autofluorescence) | AIS thrombi composed of two main types of areas: RBC rich areas and platelet rich areas. RBC-rich areas are with densely packed RBCs within a meshwork of thin fibrin strands, and very few nucleated cells or vWF. Dense fibrin structures together with vWF, delineate platelet-rich areas. Leukocytes and DNA chiefly present at the interface between RBC rich and platelet rich areas |
*All studies used TOAST classification of stroke except for reference 20.
CE, cardioembolism; CTA, CT angiography; IA, intra-arterial; IFC, immunofluorescence staining; IHC, immunohistochemical staining; LAA, large-artery atherosclerosis; MSB, Martius scarlet blue; NCCT, non-contrast CT; ODE, stroke of other determined aetiology; RBC, red blood cell; SVO, small-vessel occlusion; SVS, susceptibility vessel sign; TOAST, Trial of Org 10 172 in Acute Stroke Treatment; UDE, stroke of undetermined aetiology; vWF, von Willebrand factor; WBC, white blood cell.