The recent advances of endovascular procedures to treat stroke due to large cerebral vessel occlusion have made it possible to analyze the retrieved thrombus material. Analysis of cerebral thrombi is emerging as a relevant opportunity to complement the diagnostic workup of etiology, to develop new lytic approaches and to optimize the acute treatment of stroke due to large vessel occlusion. Nonetheless, retrieved thrombi are frequently discarded since their informative potential is often neglected and standards are missing. This review provides an overview of the current knowledge and expanding research relating to thrombus composition analysis in large vessel occlusions. We first discuss the heterogeneity of thrombogenic factors that underlie the thrombotic formation in stroke and its implications to identify stroke etiology and thrombus age. Further, we show that understanding structural characteristics of thrombus is pivotal for the development of new-targeted lytic therapies as well as to improve, through thrombus modeling, the development of thrombectomy devices. Finally, we discuss the on-going attempts to identify a signature of thrombus composition indirectly through imaging and peripheral blood biomarkers, which might in future assist treatment decision-making as well as secondary prevention. Thrombus analysis might contribute to the advancement and optimization of personalized stroke treatments.

Stroke

Etiology

10.1177/0271678x19856131

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Citations (55)

Thrombus hallmarks reveal atherothrombotic stroke aetiology

Journal of Neurology (2019)

Aurora Semerano Angela Genchi Marcella Callea Francesca Sanvito Franco Simionato

Neuroradiology

Etiology

Stroke

Ischaemic stroke

10.1007/s00415-019-09279-z

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Citations (5)

AHR DELETION REDUCES AMYLOID PLAQUE ACCUMULATION AND AXONAL DYSTROPHY IN THE APPNL-F KNOCK-IN ALZHEIMER'S MOUSE MODEL

IBRO Neuroscience Reports (2023)

Carmen Nieto‐Vaquero María Isabel Cuartero Alicia García‐Culebras Carolina Peña‐Martínez Sandra Sacristán

Amyloid (mycology)

Gene knockin

Knockout mouse

10.1016/j.ibneur.2023.08.897

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Citations (0)

Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

Case Reports in Neurological Medicine (2017)

Davide Strambo Luca Peruzzotti-Jametti Aurora Semerano Giovanna Fanelli Franco Simionato

Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1) came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

Stroke

Primary (astronomy)

10.1155/2017/2571630

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Citations (13)

[Aspects of centroencephalic epilepsy reproduced in the rabbit by administration of chlorambucil].

PubMed (1968)

Gianluca Testa Aurora Semerano P Lion

Chlorambucil

Rabbit (cipher)

Source

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Citations (1)

Neutrophils predominate the immune signature of cerebral thrombi in COVID-19 stroke patients

Acta Neuropathologica Communications (2022)

Angela Genchi Aurora Semerano Ghil Schwarz Beatrice Dell’Acqua Giorgia Serena Gullotta

Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thrombotic events. Ischemic stroke in COVID-19 patients entails high severity and mortality rates. Here we aimed to analyze cerebral thrombi of COVID-19 patients with large vessel occlusion (LVO) acute ischemic stroke to expose molecular evidence for SARS-CoV-2 in the thrombus and to unravel any peculiar immune-thrombotic features. We conducted a systematic pathological analysis of cerebral thrombi retrieved by endovascular thrombectomy in patients with LVO stroke infected with COVID-19 (n = 7 patients) and non-covid LVO controls (n = 23). In thrombi of COVID-19 patients, the SARS-CoV-2 docking receptor ACE2 was mainly expressed in monocytes/macrophages and showed higher expression levels compared to controls. Using polymerase chain reaction and sequencing, we detected SARS-CoV-2 Clade20A, in the thrombus of one COVID-19 patient. Comparing thrombus composition of COVID-19 and control patients, we noted no overt differences in terms of red blood cells, fibrin, neutrophil extracellular traps (NETs), von Willebrand Factor (vWF), platelets and complement complex C5b-9. However, thrombi of COVID-19 patients showed increased neutrophil density (MPO

Neutrophil Extracellular Traps

Stroke

ADAMTS13

10.1186/s40478-022-01313-y

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Citations (38)