Diabetes-Associated Fibrin Enrichment in Cerebral Thrombi and Its Procedural Implications for Mechanical Thrombectomy

Background/Objectives: Diabetes is associated with altered fibrin biology, but its relationship with fibrin content in cerebral thrombi and the procedural relevance of this relationship during mechanical thrombectomy remain unclear. We investigated the association between diabetes and fibrin content in thrombectomy-retrieved cerebral thrombi and whether diabetes-associated differences in fibrin content mediated procedural outcomes of mechanical thrombectomy.

Methods

We retrospectively analyzed patients with acute ischemic stroke who underwent mechanical thrombectomy and had retrieved thrombi available for histological analysis. Red blood cell, platelet, and fibrin contents were quantified immunohistochemically. The association between diabetes and fibrin content was evaluated using multivariable linear regression, with complementary sensitivity analyses based on intravenous tissue-type plasminogen activator administration and atrial fibrillation status. Mediation analyses were performed to estimate the indirect effects of diabetes on procedural outcomes through diabetes-associated changes in fibrin content.