Abstract WP346: Clot Biology Across Time: Multi-Omic Insights into Stroke Thrombi and Onset-to-Needle Intervals

Background and objectives: Histologic and transcriptomic analyses of stroke thrombi retrieved from mechanical thrombectomy have identified features associated with outcome. Yet, little information is known about how clot biology is related to time since onset in stroke. Studies have shown the predictive capacity of histology or expression features in isolation, but few have investigated how paired omics analyses can improve understanding of clot pathobiology. Our objective was to identify histomics, transcriptomics, and mechanisms associated with onset-to-needle times in stroke. Methods: We performed paired histologic/transcriptomic analyses of 32 stroke clots. The outcome variable was onset-to-needle time. Clots were H&E-stained and imaged at 40X. An established digital pathology pipeline was used to extract 237 histomic features. When dichotomized by either the high or low onset-to-needle time, differentially expressed genes (DEGs) were identified as those with absolute fold-change >1.5 and q < 0.05. DEGs were visualized in a heatmap plotted against normalized door-to-needle times. Correlation analysis between histomics and door-to-needle times was used to identify significantly correlated clot features (Pearson correlation, q-value