From the Galway Medical Technologies Centre, Galway-Mayo Institute of Technology, Ireland (S.D., L.M., E.R., E.M.).
Cerenovus, Galway Neuro Technology Centre, Ireland (S.D., R.M., M.G.).
Stroke. 2019 May;50(5):1156-1163. doi: 10.1161/STROKEAHA.118.023419.
Background and Purpose- Mechanical thrombectomy may involve multiple attempts to retrieve the occluding thrombus. This study examined the composition of thrombus fragments retrieved with each pass of a device during the thrombectomy procedure. Second, the per-pass composition was compared with procedural and clinical data including angiographic outcome and stroke etiology. Methods- Thrombi were retrieved from 60 patients with acute ischemic stroke, where thrombus fragments retrieved in each pass were segregated as individual samples and maintained throughout the histological analysis as independent samples. All samples were stained with hematoxylin and eosin and Martius Scarlet Blue. The relative composition of red blood cells, fibrin, and white blood cells in thrombus fragments from each pass was quantified. Results- Over the 60 cases, thrombus material was retrieved in 106 of 138 passes. The number of passes required to complete the cases ranged from 1 to 6 passes. The analysis of thrombus fragments retrieved in each pass provided a greater insight into the thrombectomy procedure progression than the overall thrombus composition; the red blood cell content of thrombus fragments retrieved in passes 1 and 2 was significantly higher than that retrieved in passes 3 to 6. The removal of thrombus material in a total of 1, 2, or 3 passes was associated with the highest percentage of final modified Thrombolysis in Cerebral Infarction score of 2c-3. There was no association between modified Thrombolysis in Cerebral Infarction score and per-pass thrombus composition. Conclusions- The differentiation achieved through the per-pass analysis of acute ischemic stroke thrombi provides a greater insight into the thrombectomy procedure progression than the combined per-case thrombus analysis. Insights gained may be a useful consideration in determining the treatment strategy as a case evolves and may be useful for the development of new devices to increase rates of 1-pass recanalization.
背景与目的-机械血栓切除术可能需要多次尝试来取出闭塞的血栓。本研究检查了在血栓切除术中，每次通过器械取回的血栓碎片的组成。其次，将每pass 的组成与程序和临床数据进行比较，包括血管造影结果和中风病因。
方法-从 60 例急性缺血性脑卒中患者中取出血栓，将每pass 中取出的血栓碎片分离为单独的样本，并在整个组织学分析过程中作为独立样本保存。所有样本均用苏木精和伊红以及 Martius Scarlet Blue 染色。定量分析每pass 中血栓碎片的红细胞、纤维蛋白和白细胞的相对组成。
结果-在 60 例患者中，共进行了 138 次取栓，其中有 106 次成功取出血栓材料。完成这些病例所需的取栓次数范围为 1 至 6 次。与整体血栓组成相比，分析每pass 中取出的血栓碎片提供了对血栓切除术进展的更深入了解；第 1 次和第 2 次取栓中取出的血栓碎片中的红细胞含量明显高于第 3 次至第 6 次取栓。总共取栓 1 次、2 次或 3 次与最终改良脑梗死溶栓评分（modified Thrombolysis in Cerebral Infarction score）达到 2c-3 的比例最高相关。改良脑梗死溶栓评分与每pass 血栓组成之间没有关联。
结论-通过对急性缺血性脑卒中血栓的每pass 分析，实现了比整体每例血栓分析更深入地了解血栓切除术的进展。随着病例的进展，获得的见解可能有助于确定治疗策略，并可能有助于开发新的设备来提高 1 次再通率。
