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Metagenomics Analysis of Thrombus Samples Retrieved from Mechanical Thrombectomy

Neurointervention 2021년 16권 1호 p.39 ~ 45
Vajpeyee Atulabh, Chauhan Puneet Singh, Pandey Swapnil, Tiwari Shivam, Yadav Lokendra Bahadur, Shroti Akhilesh Kumar, Vajpeyee Manisha,
소속 상세정보
 ( Vajpeyee Atulabh ) - Pacific Medical University Pacific Medical College & Hospital Deparment of Neurology
 ( Chauhan Puneet Singh ) - CSIR-National Botanical Research Institute
 ( Pandey Swapnil ) - CSIR-National Botanical Research Institute
 ( Tiwari Shivam ) - Pacific Medical University Pacific Medical College & Hospital Deparment of Neurology
 ( Yadav Lokendra Bahadur ) - Pacific Medical University Pacific Medical College & Hospital Deparment of Neurology
 ( Shroti Akhilesh Kumar ) - Pacific Medical University Pacific Medical College & Hospital Deparment of Neurology
 ( Vajpeyee Manisha ) - Pacific Medical University Pacific Medical College & Hospital Deparment of Neurology

Abstract


Purpose: The purpose of this study was to assess the microbiota in middle cerebral artery thrombi retrieved in mechanical thrombectomy arising out of symptomatic carotid plaque within 6 hours of acute ischemic stroke. Thrombi were subjected to next-generation sequencing for a bacterial signature to determine their role in atherosclerosis.

Materials and Methods: We included 4 human middle cerebral artery thrombus samples (all patients were male). The median age for the patients was 51±13.6 years. Patients enrolled in the study from Pacific Medical University and Hospital underwent mechanical thrombectomy in the stroke window period. All patients underwent brain magnetic resonance angiography (MRA) and circle of Willis and neck vessel MRA along with the standard stroke workup to establish stroke etiology. Only patients with symptomatic carotid stenosis and tandem lesions with ipsilateral middle cerebral artery occlusion were included in the study. Thrombus samples were collected, stored at ?80 degrees, and subjected to metagenomics analysis.

Results: Of the 4 patients undergoing thrombectomy for diagnosis with ischemic stroke, all thrombi recovered for bacterial DNA in qPCR were positive. More than 27 bacteria were present in the 4 thrombus samples. The majority of bacteria were Lactobacillus, Stenotrophomonas, Pseudomonas, Staphylococcus, and Finegoldia.

Conclusion: Genesis of symptomatic atherosclerotic carotid plaque leading to thromboembolism could be either due to direct mechanisms like acidification and local inflammation of plaque milieu with lactobacillus, biofilm dispersion leading to inflammation like with pseudomonas fluorescence, or enterococci or indirect mechanisms like Toll 2 like signaling by gut microbiota.

키워드

Metagenomics; Stroke; Microbiome; Thrombectomy; Thrombus

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