Department of Neurology & Neurophysiology,Liverpool Hospital,Sydney, NSW,Australia.
Department of Anatomical Pathology,Liverpool Hospital,Sydney, NSW,Australia.
Can J Neurol Sci. 2019 May;46(3):331-336. doi: 10.1017/cjn.2019.8. Epub 2019 Mar 14.
Endovascular thrombectomy (EVT) has shown efficacy in acute ischemic stroke (AIS) patients with infective endocarditis (IE). The possibility to undertake advanced histopathological clot analysis following EVT offers a new avenue to establish the etiological basis of the stroke - which is often labelled "cryptogenic." In this paper, we present our findings from four consecutive patients with IE who underwent EVT following an AIS at our tertiary referral comprehensive stroke centre.
Comprehensive histopathological analysis of clot retrieved after EVT, including morphology, was undertaken.
The consistent observation was the presence of dense paucicellular fibrinoid material mixed/interspersed with clusters of bacterial cocci. This clot morphology may be specific to septic embolus due to IE unlike incidental bacteraemia and could possibly explain the refractoriness of such clots to systemic thrombolysis.
Detailed morphological and histopathological analysis of EVT-retrieved clots including Gram staining can assist in etiological classification of the clot. Understanding the composition of the clot may be of clinical value in early diagnostics and mapping treatment planning in IE.
血管内血栓切除术（EVT）已显示出在感染性心内膜炎（IE）并发急性缺血性脑卒中（AIS）患者中的疗效。在 EVT 后进行高级组织病理学血栓分析的可能性为确定中风的病因基础提供了新途径 - 通常将其标记为“隐源性”。本文介绍了我们在我们的三级转诊综合卒中中心对 4 名因 AIS 而接受 EVT 的 IE 连续患者的发现。
对 EVT 后取出的血栓进行全面的组织病理学分析，包括形态学。
一致的观察结果是存在密集的少细胞纤维蛋白样物质，混合/散布着细菌球菌簇。这种血栓形态可能是由于 IE 引起的感染性栓子特有的，不同于偶然的菌血症，并且可能可以解释此类栓子对全身溶栓的抵抗性。
对 EVT 取出的血栓进行详细的形态学和组织病理学分析，包括革兰氏染色，可有助于对血栓的病因分类。了解血栓的组成可能对 IE 的早期诊断和治疗计划具有临床价值。
