J Stroke.  2022 May;24(2):300-302. 10.5853/jos.2021.04140.

Different Thrombus Histology in a Cancer Patient with Deep Vein Thrombosis and Recurrent Strokes

• Sun YE
• Na HK
• Kwak S
• Kim YD
• Nam HS
• Heo JH

• KMID: 2530534
• DOI: http://doi.org/10.5853/jos.2021.04140

Figure

• 

  Figure 1. Angiography images acquired before and after mechanical thrombectomy at (A) first stroke, (B) second stroke, (C) deep vein thrombosis, (D) third stroke, and (E) fourth stroke. Occlusion in the middle cerebral arteries was successfully recanalized in all cases. Occlusion of the iliac vein was successfully recanalized with thrombectomy and stenting. Empty arrow heads indicate the site of occlusion.

• 

  Figure 2. Gross and immunohistochemical findings of the arterial and venous thrombi. Thrombi from the cerebral arteries are white, while those from the vein are red. Arterial thrombi show the highest fraction of platelet, followed by fibrin. Few red blood cells are seen in the arterial thrombi. Venous thrombus shows high fractions of red blood cells and fibrin, and very low platelet fraction. Representative larger immunohistochemistry images are available in Supplementary Figure 1. The method of virtual slice acquisition and imaging analysis is discussed in Supplementary Methods.

Reference

References

1. Salem DN, Stein PD, Al-Ahmad A, Bussey HI, Horstkotte D, Miller N, et al. Antithrombotic therapy in valvular heart disease: native and prosthetic. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126(3 Suppl):457S–482S.

2. Park H, Kim J, Ha J, Hwang IG, Song TJ, Yoo J, et al. Histological features of intracranial thrombi in stroke patients with cancer. Ann Neurol. 2019; 86:143–149.

3. Heo JH, Nam HS, Kim YD, Choi JK, Kim BM, Kim DJ, et al. Pathophysiologic and therapeutic perspectives based on thrombus histology in stroke. J Stroke. 2020; 22:64–75.

4. Navi BB, Singer S, Merkler AE, Cheng NT, Stone JB, Kamel H, et al. Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology. 2014; 83:26–33.

5. Bang OY, Chung JW, Lee MJ, Seo WK, Kim GM, Ahn MJ, et al. Cancer-related stroke: an emerging subtype of ischemic stroke with unique pathomechanisms. J Stroke. 2020; 22:1–10.

6. Koutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayiotides T. Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review. Front Neurol. 2020; 11:281.

7. Yoo J, Choi JK, Kim YD, Nam HS, Park H, Lee HS, et al. Outcome of stroke patients with cancer and nonbacterial thrombotic endocarditis. J Stroke. 2020; 22:245–253.

8. Jurasz P, Alonso-Escolano D, Radomski MW. Platelet–cancer interactions: mechanisms and pharmacology of tumour cell-induced platelet aggregation. Br J Pharmacol. 2004; 143:819–826.

9. Xu XR, Yousef GM, Ni H. Cancer and platelet crosstalk: opportunities and challenges for aspirin and other antiplatelet agents. Blood. 2018; 131:1777–1789.

10. Hisada Y, Mackman N. Tissue factor and cancer: regulation, tumor growth, and metastasis. Semin Thromb Hemost. 2019; 45:385–395.