Ye Gengfan, Cao Ruoyao, Lu Jun, Qi Peng, Chen Juan, Wang Daming
Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.
Graduate School of Peking Union Medical College, Beijing, China.
Front Neurol. 2019 Aug 16;10:843. doi: 10.3389/fneur.2019.00843. eCollection 2019.
For patients with acute ischemic stroke (AIS), the thrombus density on non-enhanced CT (NECT) indicates the composition of the thrombus, a characteristic that impacts the efficacy of mechanical thrombectomy (MT). A previous meta-analysis suggested a correlation between higher thrombus density and successful reperfusion, but some new studies have drawn different conclusions. This single-center study and meta-analysis aimed to detect the association between thrombus density and reperfusion outcomes based on various thrombectomy strategies. We reviewed AIS patients who underwent MT at our center between July 2015 and May 2019. Thrombus density was recorded as mean Hounsfield Unit (HU) value on 1-mm reconstructed NECT, and expanded Thrombolysis In Cerebral Infarction (eTICI) scale was used to evaluate the reperfusion grade. The difference in thrombus density was examined according to reperfusion outcomes. Then, we systematically searched relevant literature on this issue. The random effect model was used to calculate standardized mean difference (SMD), and subgroup analysis was conducted according to MT strategies employed, including stent retriever (SR), contact aspiration (CA), Solumbra (a combination of SR and aspiration), and multiple thrombectomy modalities. Sixty-four patients with anterior circulation AIS were included in our single-center study with 57 (89.1%) achieving successful reperfusion (eTICI2b-3). Retrospective analysis showed no significant difference in thrombus density between eTICI2b-3 and eTICI0-2a reperfusion (65.27 vs. 62.19, = 0.462). As for systematic review, 11 studies were included in qualitative analysis, among which 6 had data available for meta-analysis. Pooled result showed that a comparable thrombus density between eTICI2b-3 and eTICI0-2a reperfusion (SMD 0.14, 95%CI -0.28 to 0.57, = 0.50). Interestingly, in the SR subgroup, eTICI2b-3 reperfusion showed a significant higher thrombus density (SMD 0.53, 95%CI 0.10 to 0.96, = 0.02), while an inverse trend was observed in the CA subgroup (SMD -0.48, 95%CI -0.88 to -0.07, = 0.02). Although the pooled result of meta-analysis did not show a significant association between thrombus density and successful reperfusion, subgroup analysis implicated that the SR technique might be prone to retrieve high-density thrombus, while the CA subgroup showed an opposite tendency. Further studies are needed to confirm these results and to investigate its role in the optimization of thrombectomy strategy.
对于急性缺血性卒中（AIS）患者，非增强CT（NECT）上的血栓密度可提示血栓的成分，这一特征会影响机械取栓（MT）的疗效。此前的一项荟萃分析表明，较高的血栓密度与成功再灌注之间存在相关性，但一些新研究得出了不同结论。这项单中心研究和荟萃分析旨在基于各种取栓策略检测血栓密度与再灌注结果之间的关联。我们回顾了2015年7月至2019年5月在本中心接受MT的AIS患者。血栓密度记录为1毫米重建NECT上的平均亨氏单位（HU）值，并使用扩展的脑梗死溶栓（eTICI）量表评估再灌注等级。根据再灌注结果检查血栓密度的差异。然后，我们系统检索了关于这个问题的相关文献。采用随机效应模型计算标准化均值差（SMD），并根据所采用的MT策略进行亚组分析，包括支架取栓器（SR）、接触抽吸（CA）、Solumbra（SR与抽吸相结合）以及多种取栓方式。我们的单中心研究纳入了64例前循环AIS患者，其中57例（89.1%）实现了成功再灌注（eTICI 2b - 3）。回顾性分析显示，eTICI 2b - 3与eTICI 0 - 2a再灌注之间的血栓密度无显著差异（65.27对62.19，P = 0.462）。至于系统评价，定性分析纳入了11项研究，其中6项有数据可用于荟萃分析。汇总结果显示，eTICI 2b - 3与eTICI 0 - 2a再灌注之间的血栓密度相当（SMD 0.14，95%CI -0.28至0.57，P = 0.50）。有趣的是，在SR亚组中，eTICI 2b - 3再灌注的血栓密度显著更高（SMD 0.53，95%CI 0.10至0.96，P = 0.02），而在CA亚组中观察到相反的趋势（SMD -0.48，95%CI -0.88至-0.07，P = 0.02）。尽管荟萃分析的汇总结果未显示血栓密度与成功再灌注之间存在显著关联，但亚组分析表明，SR技术可能更容易取出高密度血栓，而CA亚组则呈现相反趋势。需要进一步研究来证实这些结果，并探讨其在优化取栓策略中的作用。
