急性脑卒中的组织学血栓成分与卒中病因学或介入参数有关吗？
Is Histologic Thrombus Composition in Acute Stroke Linked to Stroke Etiology or to Interventional Parameters?
机构信息
From the Departments of Diagnostic and Interventional Radiology and Neuroradiology (J.G., I.W., M.F., C.M., A.R.)
Neuroradiological Centre (B.-J.G.), Clinic Hirslanden, Zurich, Switzerland.
出版信息
AJNR Am J Neuroradiol. 2020 Apr;41(4):650-657. doi: 10.3174/ajnr.A6467. Epub 2020 Mar 19.
BACKGROUND AND PURPOSE
Detailed insight into the composition of thrombi retrieved from patients with ischemic stroke by mechanical thrombectomy might improve pathophysiologic understanding and therapy. Thus, this study searched for links between histologic thrombus composition and stroke subtypes and mechanical thrombectomy results.
MATERIALS AND METHODS
Thrombi from 85 patients who had undergone mechanical thrombectomy for acute ischemic stroke between December 2016 and March 2018 were studied retrospectively. Thrombi were examined histologically. Preinterventional imaging features, stroke subtypes, and interventional parameters were re-analyzed. Statistical analysis was performed with the Kruskal-Wallis test, Mann-Whitney test, or Spearman correlation as appropriate.
RESULTS
Cardioembolic thrombi had a higher percentage of macrophages and a tendency toward more platelets than thrombi of large-artery atherosclerotic stenosis ( = .021 and .003) or the embolic stroke of undetermined source ( = .037 and .099) subtype. Thrombi prone to fragmentation required the combined use of contact aspiration and stent retrieval ( = .021) and were associated with an increased number of retrieving maneuvers ( = .001), longer procedural times ( = .001), and a higher lymphocyte content ( = .035).
CONCLUSIONS
We interpreted the higher macrophage and platelet content in cardioembolic thrombi compared with large-artery atherosclerotic stenosis or embolic stroke of undetermined source thrombi as an indication that the latter type might be derived from an atherosclerotic plaque rather than from an undetermined cardiac source. The extent of thrombus fragmentation was associated with a more challenging mechanical thrombectomy and a higher lymphocyte content of the thrombi. Thus, thrombus fragmentation not only might be caused by the recanalization procedure but also might be a feature of a lymphocyte-rich, difficult-to-retrieve subgroup of thrombi.
背景与目的
通过机械取栓从缺血性卒中患者中取出的血栓的详细成分可能会提高对病理生理的理解并改善治疗效果。因此，本研究旨在寻找组织学血栓成分与卒中亚型和机械取栓结果之间的关联。
材料与方法
回顾性分析了 2016 年 12 月至 2018 年 3 月期间 85 例行机械取栓治疗的急性缺血性卒中患者的血栓。对血栓进行了组织学检查。重新分析了介入前影像学特征、卒中亚型和介入参数。采用 Kruskal-Wallis 检验、Mann-Whitney 检验或 Spearman 相关分析进行统计学分析。
结果
心源性栓塞性血栓中的巨噬细胞比例较高，血小板比例也有增高趋势，与大动脉粥样硬化狭窄（ =.021 和.003）或不明来源栓塞性卒中（ =.037 和.099）亚型的血栓相比。易于碎裂的血栓需要联合使用接触抽吸和支架回收（ =.021），与更多的回收操作（ =.001）、更长的手术时间（ =.001）和更高的淋巴细胞含量（ =.035）相关。
结论
与大动脉粥样硬化狭窄或不明来源栓塞性卒中的血栓相比，心源性栓塞性血栓中的巨噬细胞和血小板含量较高，我们将其解释为后者可能来源于粥样斑块，而不是未知的心脏来源。血栓碎裂的程度与更具挑战性的机械取栓和血栓中更高的淋巴细胞含量相关。因此，血栓碎裂不仅可能是再通过程引起的，而且可能是一个富含淋巴细胞、难以回收的血栓亚群的特征。
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