From the Institute of Clinical Radiology (P.B.S., M.W., W.H., A.K.), University Hospital of Muenster, Germany.
Institute of Neuropathology (A.J.), University Hospital of Muenster, Germany.
Stroke. 2019 Aug;50(8):2065-2071. doi: 10.1161/STROKEAHA.118.023314. Epub 2019 Jun 27.
Background and Purpose- The introduction of stent retrievers allows for a complete extraction and histological analysis of human clots. Initial studies describe an impact of preinterventional clot migration on technical and clinical success of thrombectomy and an association with worse clinical outcome. We, therefore, performed a large study of consecutive patients whose clots have been histologically analyzed and tried to determine whether clot composition influences the rates of clot migration and thereby interventional and clinical outcome. Methods- We retrospectively evaluated data of a prospectively collected cohort of 198 consecutive patients with occlusion of the middle cerebral artery. We investigated the relationship between clot histology expressed as percentage of the main components (fibrin, erythrocytes [red blood cell], and white blood cells), the preinterventional computed tomography attenuation of the emboli, embolus length, and clot migration. We defined a binary outcome (clot migration versus no clot migration). The impact of embolus composition and computed tomography features was assessed in univariable and multivariable logistic regression models. Results- One hundred sixty-three patients fulfilled the inclusion criteria, of which 36 (22.1%) showed a clot migration. Patients with proven clot migration had significantly higher levels of red blood cells than patients without clot migration (median 50% versus 26%, P<0.001). Lower amounts of fibrin were significantly more often observed in patients in the clot migration group as compared to the no clot migration group (43.5% versus 62.0%, P<0.001). Stroke cause did not differ between migrated and stable emboli. Multivariable analysis identified a higher amount of erythrocytes (adjusted odds ratio, 1.03 per median percentage, P<0.001) and a shorter embolus length (adjusted odds ratio, 0.90 per mm, P<0.008) as independent predictors of clot migration. Conclusions- Erythrocyte-rich clots and a shorter embolus length are independent reliable predictors for clot migration. This finding is clinically important as clot migration might have a negative impact on technical and clinical outcomes of patients suffering from emergent vessel occlusions of the middle cerebral artery undergoing endovascular therapy.
背景与目的-支架取栓器的引入使得能够完整地提取和分析人体血栓，并进行组织学检查。最初的研究表明，血栓在介入前的迁移会影响血栓切除术的技术和临床成功率，并与更差的临床结果相关。因此，我们对接受了组织学分析的连续患者进行了一项大型研究，试图确定血栓成分是否会影响血栓迁移的发生率，进而影响介入和临床结果。方法-我们回顾性评估了一项前瞻性收集的 198 例大脑中动脉闭塞患者队列的数据。我们研究了血栓组织学（以主要成分（纤维蛋白、红细胞[红细胞]和白细胞）的百分比表示）、栓塞前 CT 衰减、栓塞长度和血栓迁移之间的关系。我们定义了二元结局（血栓迁移与无血栓迁移）。在单变量和多变量逻辑回归模型中评估了栓塞成分和 CT 特征的影响。结果-163 例患者符合纳入标准，其中 36 例（22.1%）发生了血栓迁移。与无血栓迁移的患者相比，证实有血栓迁移的患者的红细胞水平明显更高（中位数 50%比 26%，P<0.001）。与无血栓迁移组相比，在血栓迁移组中，纤维蛋白的含量明显更低（43.5%比 62.0%，P<0.001）。在迁移和稳定的栓塞中，中风的病因没有差异。多变量分析确定了红细胞含量更高（调整优势比，每中位数百分比增加 1.03，P<0.001）和栓塞长度更短（调整优势比，每毫米减少 0.90，P<0.008）是血栓迁移的独立预测因子。结论-富含红细胞的血栓和较短的栓塞长度是血栓迁移的独立可靠预测因子。这一发现具有重要的临床意义，因为血栓迁移可能会对接受血管内治疗的大脑中动脉紧急闭塞患者的技术和临床结果产生负面影响。
