Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Neurointerv Surg. 2021 May;13(5):409-414. doi: 10.1136/neurintsurg-2020-016228. Epub 2020 Jul 20.
Different imaging characteristics such as clot burden score, collaterals, and pre-interventional thrombus migration are associated with functional outcome in patients with acute ischemic stroke. Moreover, histological thrombus composition is associated with pre-interventional thrombus migration. We hypothesized that smaller clots may more likely migrate and that collateral status in ischemic stroke patients may mediate this tendency of the clot to migrate.
In this prospective cohort of consecutive ischemic stroke patients, clot burden scores and collateral scores were rated and the retrieved thrombi were histologically analyzed. We then investigated the relationship between clot burden score, probability for thrombus migration, and collateral scores using mediation analysis.
163 patients are included of which 36 (22.1%) had a clot migration. Probability of thrombus migration was significantly associated with lower collateral scores (P<0.01), higher clot burden scores (P<0.01), shorter thrombi (P<0.01), and higher RBC count (P<0.01). In the mediator pathway, higher collateral scores were significantly associated with higher clot burden scores (P<0.01) and younger age (P=0.029). The total effect of an increase in clot burden score by one grade on thrombus migration is composed of the direct effect (+18%, P<0.01) and the collateral score-mediated indirect effect (-5%, P<0.01).
Smaller, erythrocyte-rich thrombi tend to migrate more often. Good collaterals seem to have a considerable effect on limiting migration. This supports the hypothesis that larger clots have stronger adherence with the vessel wall and that good collaterals increase the counter pressure distal of the clot.
不同的成像特征，如血栓负荷评分、侧支循环和介入前血栓迁移，与急性缺血性脑卒中患者的功能结局相关。此外，血栓的组织学组成与介入前血栓迁移有关。我们假设较小的血栓可能更容易迁移，而缺血性脑卒中患者的侧支循环状况可能会影响这种血栓迁移的趋势。
在这项连续缺血性脑卒中患者的前瞻性队列研究中，我们对血栓负荷评分和侧支循环评分进行了评估，并对提取的血栓进行了组织学分析。然后，我们使用中介分析研究了血栓负荷评分、血栓迁移概率与侧支循环评分之间的关系。
共纳入 163 例患者，其中 36 例（22.1%）发生了血栓迁移。血栓迁移的概率与较低的侧支循环评分（P<0.01）、较高的血栓负荷评分（P<0.01）、较短的血栓（P<0.01）和较高的红细胞计数（P<0.01）显著相关。在中介途径中，较高的侧支循环评分与较高的血栓负荷评分（P<0.01）和较年轻的年龄（P=0.029）显著相关。血栓负荷评分增加一级对血栓迁移的总效应由直接效应（+18%，P<0.01）和侧支循环评分介导的间接效应（-5%，P<0.01）组成。
富含红细胞的较小血栓更倾向于迁移。良好的侧支循环似乎对限制迁移有相当大的影响。这支持了这样一种假设，即较大的血栓与血管壁的粘附更强，良好的侧支循环增加了血栓远端的反向压力。
