Department of General Pathology, Kazan State Medical University (R.R.K., A.Z.S.), Russian Federation.
Institute of Fundamental Medicine and Biology, Kazan Federal University (R.R.K., A.Z.S., R.I.L.), Russian Federation.
Stroke. 2020 Dec;51(12):3640-3650. doi: 10.1161/STROKEAHA.120.031559. Epub 2020 Oct 12.
The purpose was to assess quantitatively and qualitatively the composition and structure of cerebral thrombi and correlate them with the signs of intravital clot contraction (retraction), as well as with etiology, severity, duration, and outcomes of acute ischemic stroke.
We quantified high-resolution scanning electron micrographs of 41 cerebral thrombi for their detailed cellular and noncellular composition and analyzed histological images for the overall structure with the emphasis on red blood cell compression, fibrin age, and the signs of inflammation.
Cerebral thrombi were quite compact and had extremely low porosity. The prevailing cell type was polyhedral compressed erythrocytes (polyhedrocytes) in the core, and fibrin-platelet aggregates were concentrated at the periphery; both findings are indicative of intravital contraction of the thrombi. The content of polyhedrocytes directly correlated with the stroke severity. The prevalence of fibrin bundles was typical for more severe cases, while the content of fibrin sponge prevailed in cases with a more favorable course. The overall platelet content in cerebral thrombi was surprisingly small, while the higher content of platelet aggregates was a marker of stroke severity. Fibrillar types of fibrin prevailed in atherothrombogenic thrombi. Older fibrin prevailed in thrombi from the patients who received thrombolytics, and younger fibrin dominated in cardioembolic thrombi. Alternating layers of erythrocytes and fibrin mixed with platelets were common for thrombi from the patients with more favorable outcomes. Thrombi with a higher number of leukocytes were associated with fatal cases.
Most cerebral thrombi undergo intravital clot contraction (retraction) that may be of underestimated clinical importance. Despite the high variability of the composition and structure of cerebral thrombi, the content of certain types of blood cells and fibrin structures combined with the morphological signs of intravital contraction correlate with the clinical course and outcomes of acute ischemic stroke.
本研究旨在定量和定性评估脑血栓的组成和结构，并将其与活体血栓收缩（回缩）的迹象相关联，同时还与病因、严重程度、病程和急性缺血性脑卒中的结局相关联。
我们对 41 例脑血栓进行了高分辨率扫描电子显微镜图像的定量分析，以了解其详细的细胞和非细胞组成，并通过对整体结构的组织学图像分析，重点关注红细胞的压缩、纤维蛋白的年龄以及炎症的迹象。
脑血栓非常致密，孔隙率极低。核心中占主导地位的细胞类型是多面形压缩红细胞（多形红细胞），纤维蛋白-血小板聚集体集中在周边；这两种发现都表明血栓发生了活体收缩。多形红细胞的含量与卒中严重程度直接相关。纤维束的普遍存在提示更严重的病例，而纤维海绵的含量则提示预后较好的病例。脑血栓中血小板的总体含量出人意料地低，而血小板聚集体含量较高则是卒中严重程度的标志物。纤维蛋白的纤维状类型在动脉粥样硬化血栓中更为常见。在接受溶栓治疗的患者的血栓中，较陈旧的纤维蛋白更为常见，而在心源性栓塞性血栓中则以年轻的纤维蛋白为主。红细胞和纤维蛋白与血小板混合的交替层在预后较好的患者的血栓中很常见。白细胞数量较多的血栓与致死性病例有关。
大多数脑血栓发生活体血栓收缩（回缩），这可能被低估了其临床重要性。尽管脑血栓的组成和结构具有高度的可变性，但某些类型的血细胞和纤维蛋白结构的含量与活体收缩的形态学迹象与急性缺血性脑卒中的临床病程和结局相关联。
