Abstract
Acute Ischemic Stroke (AIS) is a major public health burden, involving several diagnostics, therapeutic and prognostic concerns.Endovascular treatment (EVT), using stent-retriever, aspiration or combination of both techniques, has been validated in 2015 for patients presenting with AIS involving large vessel occlusion (LVO) of the anterior circulation. Besides a major clinical impact on AIS prognostic, EVT has allowed access to biological material sampled at the intracranial level.First studies in that context have focused on the intracranial thrombus retrieved by EVT, describing reported variable histological architecture of cerebral thrombi, or correlation between histological composition of intracranial thrombi and their radiological appearance.Several studies have tried to correlate histological composition of intracranial thrombi and stroke etiology, regarding that a high proportion (30-40%) of strokes remains cryptogenic despite an exhaustive work-up and that secondary prevention (impacting stroke recurrence risk) is based on stroke etiology. However, these studies, mainly based on standard histological techniques, have given conflictual results, with limitations concerns due to the lack of consensus allowing reproductive histological classification of intracranial thrombi.Our work begins in 2015, with an immunohistochemical study focusing on CD3+ T-cell content in intracranial thrombi retrieved from AIS patients with LVO, relating that marker to the stroke etiology (either cardioembolic or atherosclerotic).Second part of the work focused on the proteomic analysis of cardioembolic and atherothrombotic thrombi, using mass-spectrometry, and applying a support-vector machine learning routine to identify protein candidates segregating the two selected populations.Finally, we analyzed a large panel of biomarkers (cytokines, chemokines and adhesive molecules) sampled intracranially beyond the arterial occlusion in a cohort of patients with AIS and LVO, and their correlation with baseline and follow-up clinicoradiological data. Keywords: acute ischemic stroke, thrombectomy, endovascular treatment, thrombus, clot, neuroradiology, mass-spectrometry, proteomics