Analysis of cholesterol crystals in thrombi obtained from endovascular treatment of acute ischemic stroke

Abstract

Objective To compare the difference of the rate of cholesterol crystals in thrombi obtained from patients of acute ischemic stroke with different etiologies and the effect of thrombi containing cholesterol crystals on vascular recanalization.  Methods A total of 92 patients with acute ischemic stroke caused by intracranial large vascular occlusion underwent endovascular treatment, such as catheter suction, thrombectomy, balloon dilatation and stent implantation. Histopathological examinations of the retrieved thrombi were performed.  Results Of 92 cases, 81 cases (88.04%) achieved recanalization [Thrombolysis in Cerebral Infarction (TICI) ≥ 2b]. Thrombi were retrieved in 66 cases (71.74%) and 63 cases (68.48%)performed pathological examinations, among whom 26 cases (41.27%) were atherothrombosis (AT), 24 cases (38.10%) were cardioembolism (CE), 2 (3.17%) were stroke of other determined etiology (SOD) and 11 cases (17.46%) were stroke of undetermined etiology (SUD). Among 26 AT cases, 18 cases (69.23%) accepted endovascular treatment and 8 cases (30.77% ) accepted bridging therapy. One case (3.85% ) underwent catheter suction, and 25 cases (96.15%) underwent thrombectomy, including thrombectomy alone in 9 cases (34.62% ), thrombectomy combined with balloon dilatation in 3 cases (11.54% ), thrombectomy combined with stent implantation in 3 cases (11.54% ), thrombectomy combined with balloon dilatation and stent implantation in 10 cases (38.46%), respectively. Cholesterol crystals were detected in 4 cases (15.38%). There was no significant difference in the number of thrombectomy between thrombi with cholesterol crystals and those without cholesterol crystals [2.50 (2.00, 3.00) times vs. 2 (2, 2) times; Z = ? 1.155, P = 0.248]. Among 37 non ? AT cases, 26 cases (70.27% ) accepted endovascular treatment and 11 cases (29.73%) accepted bridging therapy. All of them underwent thrombectomy, including thrombectomy alone in 34 cases (91.89%), thrombectomy combined with balloon dilatation in one case (2.70%), thrombectomy combined with stent implantation in 2 cases (5.41% ), respectively. There was statistically significant difference in the rate of cholesterol crystals between AT cases and non?AT cases [15.38% (4/26) vs. 0/37， Fisher's exact probability: P = 0.025]. There was no significant difference in the rate of cholesterol crystals between patients with and without recanalization [3.77% (2/53) vs. 2/10, Fisher's exact probability: P = 0.115]. Conclusions Although the rate of cholesterol crystals in thrombi of acute ischemic stroke patients is relatively low, it is specific for diagnosing AT. Besides, cholesterol crystals has no relationship with vascular recanalization.

DOI: 10.3969/j.issn.1672-6731.2018.05.011