Niesten Joris M, van der Schaaf Irene C, van Dam Lievay, Vink Aryan, Vos Jan Albert, Schonewille Wouter J, de Bruin Peter C, Mali Willem P T M, Velthuis Birgitta K
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
PLoS One. 2014 Feb 11;9(2):e88882. doi: 10.1371/journal.pone.0088882. eCollection 2014.
We related composition of cerebral thrombi to stroke subtype and attenuation on non-contrast CT (NCCT) to gain more insight in etiopathogenesis and to validate thrombus attenuation as a new imaging biomarker for acute stroke.
We histopathologically investigated 22 thrombi retrieved after mechanical thrombectomy in acute stroke patients. First, thrombi were classified as fresh, lytic or organized. Second, percentages of red blood cells (RBCs), platelets and fibrin and number of red, white (respectively RBCs or platelets outnumbering other components with ≥ 15%) or mixed thrombi were compared between large artery atherosclerosis (LAA), cardioembolism, dissection and unknown subtype. Third, correlation between attenuation and RBCs, platelets and fibrin was calculated using Pearson's correlation coefficients (r).
Thrombi were fresh in 73% (n = 16), lytic in 18% (n = 4) and organized in 9% (n = 2). The stroke cause was LAA in eight (36%), cardioembolism in six (27%), dissection in three (14%), and unknown in five (23%) patients. LAA thrombi showed the highest percentage RBCs (median 50 (range 35-90)), followed by dissection (35 (20-40), p = 0.05), cardioembolism (35 (5-45), p = 0.013) and unknown subtype (25 (2-40), p = 0.006). No differences in platelets (p = 0.16) and fibrin (p = 0.52) between subtypes were found. LAA thrombi were classified as red or mixed (both n = 4), cardioembolisms as mixed (n = 5) or white (n = 1) and dissection as mixed (n = 3). There was a moderate positive correlation between attenuation and RBCs (r = 0.401, p = 0.049), and weak negative correlations with platelets (r = -0.368, p = 0.09) and fibrin (r = -0.073, p = 0.75).
The majority of cerebral thrombi is fresh. There are no differences in age of thrombi between subtypes. LAA thrombi have highest percentages RBCs, cardioembolism and unknown subtype lowest. No relationship exists between subtype and platelets or fibrin percentages. We found a correlation between the RBC-component and thrombus attenuation, which improves validation of thrombus attenuation on NCCT as an imaging biomarker for stroke management.
我们将脑栓子的成分与卒中亚型以及非增强CT（NCCT）上的衰减情况相关联，以更深入了解病因发病机制，并验证血栓衰减作为急性卒中的一种新的影像学生物标志物。
我们对急性卒中患者机械取栓后取出的22个血栓进行了组织病理学研究。首先，将血栓分为新鲜、溶解或机化型。其次，比较大动脉粥样硬化（LAA）、心源性栓塞、夹层分离和不明亚型之间红细胞（RBC）、血小板和纤维蛋白的百分比以及红色、白色（分别指RBC或血小板数量超过其他成分≥15%）或混合性血栓的数量。第三，使用Pearson相关系数（r）计算衰减与RBC、血小板和纤维蛋白之间的相关性。
73%（n = 16）的血栓为新鲜型，18%（n = 4）为溶解型，9%（n = 2）为机化型。8例（36%）患者的卒中病因是LAA，6例（27%）是心源性栓塞，3例（14%）是夹层分离，5例（23%）病因不明。LAA血栓中RBC的百分比最高（中位数50（范围35 - 90）），其次是夹层分离（35（20 - 40），p = 0.05）、心源性栓塞（35（5 - 45），p = 0.013）和不明亚型（25（2 - 40），p = 0.006）。各亚型之间血小板（p = 0.16）和纤维蛋白（p = 0.52）无差异。LAA血栓分为红色或混合性（均为n = 4），心源性栓塞分为混合性（n = 5）或白色（n = 1），夹层分离分为混合性（n = 3）。衰减与RBC之间存在中度正相关（r = 0.401，p = 0.049），与血小板存在弱负相关（r = -0.368，p = 0.09），与纤维蛋白存在弱负相关（r = -0.073，p = 0.75）。
大多数脑栓子是新鲜的。各亚型之间血栓的年龄无差异。LAA血栓中RBC的百分比最高，心源性栓塞和不明亚型最低。亚型与血小板或纤维蛋白百分比之间无关联。我们发现RBC成分与血栓衰减之间存在相关性，这有助于验证NCCT上的血栓衰减作为卒中管理的影像学生物标志物。
