Thrombus composition identifies distinct etiologic phenotypes in embolic stroke of undetermined source.
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| Title: | Thrombus composition identifies distinct etiologic phenotypes in embolic stroke of undetermined source. |
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| Authors: | Schwarz, Ghil (AUTHOR), Bellavia, Simone (AUTHOR), Aquilano, Maria Costanza (AUTHOR), di Como, Martina (AUTHOR), Valtorta, Emanuele (AUTHOR), Bonoldi, Emanuela (AUTHOR), Macera, Antonio (AUTHOR), Cervo, Amedeo (AUTHOR), Pero, Guglielmo Carlo (AUTHOR), Tolva, Valerio (AUTHOR), Piano, Mariangela (AUTHOR), Sessa, Maria (AUTHOR), Rizzo, Angelo Cascio (AUTHOR) |
| Source: | Neurological Sciences. May2026, Vol. 47 Issue 5, p1-10. 10p. |
| Abstract: | Background and aims: Embolic stroke of undetermined source (ESUS) is biologically heterogeneous and often presumed cardioembolic (CE). We investigated whether thrombus composition can capture etiologic heterogeneity within ESUS, clarifying its overall similarity to CE stroke and exploring whether selected radiological features are associated with atherothrombotic-like thrombus patterns. Methods: Retrospective single-center study of anterior-circulation ischemic stroke patients treated with mechanical thrombectomy (MT) (2022–2025) with available thrombus, classified as large-artery atherosclerosis (LAA), CE, or ESUS. Thrombus composition (RBCs, fibrin, leukocytes; % thrombus area) was analyzed using prespecified non-parametric hierarchical comparisons with Bonferroni correction (k = 3). Reference analyses compared LAA vs. CE; primary analyses ESUS vs. LAA and CE; secondary and tertiary analyses stratified ESUS by ipsilateral high-risk non-stenotic carotid plaque (hrNSCP − vs. hrNSCP+, defined by CTA-based Plaque-RADS score 3–4). Robustness was assessed using isometric log-ratio transformation and exploratory multivariable models. Results: Among 344 MT-treated patients, 159 (46.2%) were included (91 CE, 18 LAA, 50 ESUS). LAA and CE showed distinct thrombus profiles, with higher RBC and lower fibrin content in LAA compared with CE (p < 0.01). ESUS thrombi were descriptively CE-like, without significant differences versus CE or LAA after correction. After stratification, two distinct and biologically coherent thrombus phenotypes emerged: ESUS hrNSCP− (n = 42) thrombi overlapped with CE, whereas ESUS hrNSCP+ (n = 8) thrombi were indistinguishable from LAA; these patterns were confirmed by compositional and multivariable analyses. Conclusions: When etiologic heterogeneity is taken into account, thrombus composition reveals distinct cardioembolic-like and atherothrombotic-like patterns within ESUS, supporting its role as a complementary tool for etiologic attribution alongside clinical and imaging data. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 193103198 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Thrombus composition identifies distinct etiologic phenotypes in embolic stroke of undetermined source. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Schwarz%2C+Ghil%22">Schwarz, Ghil</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bellavia%2C+Simone%22">Bellavia, Simone</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Aquilano%2C+Maria+Costanza%22">Aquilano, Maria Costanza</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22di+Como%2C+Martina%22">di Como, Martina</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Valtorta%2C+Emanuele%22">Valtorta, Emanuele</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bonoldi%2C+Emanuela%22">Bonoldi, Emanuela</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Macera%2C+Antonio%22">Macera, Antonio</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cervo%2C+Amedeo%22">Cervo, Amedeo</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pero%2C+Guglielmo+Carlo%22">Pero, Guglielmo Carlo</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tolva%2C+Valerio%22">Tolva, Valerio</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Piano%2C+Mariangela%22">Piano, Mariangela</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sessa%2C+Maria%22">Sessa, Maria</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rizzo%2C+Angelo+Cascio%22">Rizzo, Angelo Cascio</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Neurological+Sciences%22">Neurological Sciences</searchLink>. May2026, Vol. 47 Issue 5, p1-10. 10p. – Name: Abstract Label: Abstract Group: Ab Data: Background and aims: Embolic stroke of undetermined source (ESUS) is biologically heterogeneous and often presumed cardioembolic (CE). We investigated whether thrombus composition can capture etiologic heterogeneity within ESUS, clarifying its overall similarity to CE stroke and exploring whether selected radiological features are associated with atherothrombotic-like thrombus patterns. Methods: Retrospective single-center study of anterior-circulation ischemic stroke patients treated with mechanical thrombectomy (MT) (2022–2025) with available thrombus, classified as large-artery atherosclerosis (LAA), CE, or ESUS. Thrombus composition (RBCs, fibrin, leukocytes; % thrombus area) was analyzed using prespecified non-parametric hierarchical comparisons with Bonferroni correction (k = 3). Reference analyses compared LAA vs. CE; primary analyses ESUS vs. LAA and CE; secondary and tertiary analyses stratified ESUS by ipsilateral high-risk non-stenotic carotid plaque (hrNSCP − vs. hrNSCP+, defined by CTA-based Plaque-RADS score 3–4). Robustness was assessed using isometric log-ratio transformation and exploratory multivariable models. Results: Among 344 MT-treated patients, 159 (46.2%) were included (91 CE, 18 LAA, 50 ESUS). LAA and CE showed distinct thrombus profiles, with higher RBC and lower fibrin content in LAA compared with CE (p < 0.01). ESUS thrombi were descriptively CE-like, without significant differences versus CE or LAA after correction. After stratification, two distinct and biologically coherent thrombus phenotypes emerged: ESUS hrNSCP− (n = 42) thrombi overlapped with CE, whereas ESUS hrNSCP+ (n = 8) thrombi were indistinguishable from LAA; these patterns were confirmed by compositional and multivariable analyses. Conclusions: When etiologic heterogeneity is taken into account, thrombus composition reveals distinct cardioembolic-like and atherothrombotic-like patterns within ESUS, supporting its role as a complementary tool for etiologic attribution alongside clinical and imaging data. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10072-026-09021-4 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 10 StartPage: 1 Titles: – TitleFull: Thrombus composition identifies distinct etiologic phenotypes in embolic stroke of undetermined source. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Schwarz, Ghil – PersonEntity: Name: NameFull: Bellavia, Simone – PersonEntity: Name: NameFull: Aquilano, Maria Costanza – PersonEntity: Name: NameFull: di Como, Martina – PersonEntity: Name: NameFull: Valtorta, Emanuele – PersonEntity: Name: NameFull: Bonoldi, Emanuela – PersonEntity: Name: NameFull: Macera, Antonio – PersonEntity: Name: NameFull: Cervo, Amedeo – PersonEntity: Name: NameFull: Pero, Guglielmo Carlo – PersonEntity: Name: NameFull: Tolva, Valerio – PersonEntity: Name: NameFull: Piano, Mariangela – PersonEntity: Name: NameFull: Sessa, Maria – PersonEntity: Name: NameFull: Rizzo, Angelo Cascio IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 05 Text: May2026 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 15901874 Numbering: – Type: volume Value: 47 – Type: issue Value: 5 Titles: – TitleFull: Neurological Sciences Type: main |
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