1 Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
2 Department of Pathology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Cell Transplant. 2019 Jun;28(6):684-690. doi: 10.1177/0963689718823206. Epub 2019 Jan 18.
Mechanical thrombectomy (MT) is effective in managing patients with acute ischemic stroke (AIS) caused by large-vessel occlusions and allows for valuable histological analysis of thrombi. However, whether bridging therapy (pretreatment with intravenous thrombolysis before MT) provides additional benefits in patients with middle cerebral artery (MCA) occlusion remains unclear. Therefore, this study aimed to compare the effects of direct MT and bridging therapy, and to elucidate the correlation between thrombus composition and stroke subtypes. Seventy-three patients with acute ischemic stroke who received MT, were eligible for intravenous thrombolysis, and had MCA occlusion were included. We matched 21 direct MT patients with 21 bridging therapy patients using propensity score matching and compared their 3rd-month clinical outcomes. All MCA thrombi (n = 45) were histologically analyzed, and the red blood cell (RBC) and fibrin percentages were quantified. We compared the clot composition according to stroke etiology (large-artery atherosclerosis and cardioembolism) and intravenous thrombolysis application. The baseline characteristics showed no difference between groups except for a higher atrial fibrillation rate and NIHSS score on admission in the direct MT group. We performed a supportive analysis using propensity score matching but could not find any differences in the functional outcome, mortality, and intracerebral hemorrhage. In the histological clot analysis, the cardioembolic clots without intravenous thrombolysis pretreatment had higher RBC (P = 0.042) and lower fibrin (P = 0.042) percentages than the large-artery atherosclerosis thrombi. Similar findings were observed in the thrombi treated with recombinant tissue plasminogen activator (P = 0.012). In conclusion, there was no difference in the functional outcomes between the direct MT and bridging therapy groups. However, randomized trials are needed to elucidate the high ratio of cardioembolism subtype in our group of patients. The histological MCA thrombus composition differed between cardioembolism and large-artery atherosclerosis, and this finding provides valuable information on the underlying pathogenesis and thrombus origin.
机械取栓 (MT) 对治疗由大血管闭塞引起的急性缺血性脑卒中 (AIS) 患者有效，并允许对血栓进行有价值的组织学分析。然而，对于大脑中动脉 (MCA) 闭塞的患者，桥接治疗（MT 前进行静脉溶栓治疗）是否提供额外的益处尚不清楚。因此，本研究旨在比较直接 MT 和桥接治疗的效果，并阐明血栓成分与脑卒中亚型之间的关系。73 名接受 MT 治疗且适合静脉溶栓且 MCA 闭塞的急性缺血性脑卒中患者符合入选标准。我们通过倾向评分匹配将 21 名直接 MT 患者与 21 名桥接治疗患者进行匹配，并比较了他们的 3 个月临床转归。对所有 45 例 MCA 血栓进行了组织学分析，并对红细胞 (RBC) 和纤维蛋白百分比进行了定量。我们根据脑卒中病因（大动脉粥样硬化和心源性栓塞）和静脉溶栓应用比较了血栓成分。基线特征显示两组之间除直接 MT 组入院时心房颤动发生率和 NIHSS 评分较高外，无差异。我们使用倾向评分匹配进行了辅助分析，但在功能结局、死亡率和颅内出血方面未发现差异。在组织学血栓分析中，未经静脉溶栓预处理的心源性栓塞性血栓的 RBC 百分比较高（P = 0.042），纤维蛋白百分比较低（P = 0.042），而大动脉粥样硬化性血栓则相反。在使用重组组织型纤溶酶原激活剂治疗的血栓中也观察到了类似的发现（P = 0.012）。总之，直接 MT 和桥接治疗组的功能结局无差异。然而，需要随机试验来阐明我们组患者中高比例的心源性栓塞亚型。MCA 血栓的组织学组成在心源性栓塞和大动脉粥样硬化之间存在差异，这一发现为潜在发病机制和血栓起源提供了有价值的信息。
