Thrombo-pathologic features and prognosis of acute ischemic stroke patients treated with remedial stent implantation.

Background: Remedial stenting (RS) is a crucial therapy for people with acute ischemic stroke (AIS) if blood flow cannot be maintained following thrombus removal. Still, not much is known about the thrombus composition in these patients. Therefore, this study aims to compare the thrombo-pathological features of patients with AIS undergoing RS and non-remedial stenting (NRS) and to examine the correlation between thrombus composition and prognosis in patients with RS. Methods: This study included 89 patients with AIS who underwent endovascular thrombolysis. Patients were classified into RS and NRS groups based on modified thrombolysis in cerebral infarction (mTICI) scores. The primary thrombus components were identified using ICH and HE staining. The study also examined the association between thrombus components and patient prognosis. Results: The levels of neutrophil extracellular traps (NET) [0.41 (0.34, 0.61) vs. 0.36 (0.31, 0.40)], CD163 [0.31 (0.23, 0.38) vs. 0.21 (0.18, 0.23)], and C-reactive protein (CRP) [0.33 (0.26, 0.42) vs. 0.27 (0.22, 0.33)] were significantly higher in the RS group compared to the NRS group. After adjusting for other variables, both von Willebrand factor (VWF) and CD163 were associated with poor prognosis in stented patients (P < 0.05). The adjusted odds ratio (OR) for VWF was 2.87 × 106 (95% CI: 14.44-5.71 × 1011), and the adjusted OR for CD163 was 4,838.64 (95% CI: 1.86-1.26 × 107). Receiver operating characteristic (ROC) curve areas for VWF and CD163 in relation to poor prognosis in AIS patients 90 days after RS implantation was 0.7256 (95% CI: 0.5630-0.8870) and 0.7639 (95% CI: 0.6163-0.9115), respectively. Conclusions: Thrombi from the RS and NRS groups exhibited variations in NET, CD163, and CRP levels. In the RS group, poor patient prognosis strongly correlates with VWF and CD163 levels in the thrombi.