Correlation of Thrombus Immune Cell Composition and Clinical Outcome in Acute Ischemic Stroke: A MR CLEAN-NO IV sub-study

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Background and Objectives The immune system is increasingly recognized as a contributor to thrombus formation and outcomes in acute ischemic stroke (AIS). We aimed to characterize immune cell composition in thrombi retrieved during endovascular thrombectomy and evaluate its association with thrombus morphology, stroke etiology, and clinical outcomes. Methods Thrombi from 56 patients in the MR CLEAN-NO IV study were analyzed histologically for immune cell densities. Outcomes included thrombus volume, 90-day functional outcome (modified Rankin Scale ≥3), National Institutes of Health Stroke Scale (NIHSS) at 24h and 7d, mortality, successful recanalization, final infarct volume, and procedure variables. Results Median age was 69 years, 33.9% female, median baseline NIHSS 17, and 51.8% received intravenous thrombolysis. Immune cell expression was not associated with thrombus morphology. However, cardioembolic (CE) thrombi exhibited higher CD68 + cell density compared with large artery atherosclerosis (p=0.016) and cryptogenic thrombi (p=0.034). In CE thrombi, CD19 + and Congo Red + cell densities were positively correlated with thrombus volume (linear regression β=37.98, 95% CI [12.63-63.33], p=0.020; β=54.05, 95% CI [-17.69-90.32], p=0.023, respectively). Furthermore, higher CD3 + and Congo Red + cell densities were independently associated with favorable 90-day functional outcome (OR=0.37, 95% CI [0.17-0.72], p=0.006; OR=0.28, 95% CI [0.08-0.70], p=0.020, respectively). Conclusion Immune cell composition within retrieved thrombi may vary depending on stroke etiology and might be relevant for treatment strategy and clinical recovery. The exploratory results of this study suggest a possible role for immunothrombosis in AIS. However, further validation in larger-sample, adjusted analyses is needed before any clinical significance can be derived.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.