Department of Neurology (C.-H.F., C.-H.C., L.-K.T., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei.
Department of Medical Imaging (Y.-H.L., C.-W.L.), National Taiwan University Hospital, Taipei.
Stroke. 2020 Dec;51(12):3723-3727. doi: 10.1161/STROKEAHA.120.032069. Epub 2020 Nov 3.
We aim to investigate whether histopathologic examination of thrombi retrieved from acute ischemic stroke patients undergoing endovascular treatment could distinguish cancer-related stroke from other etiologies.
Thrombi from patients undergoing endovascular treatment were analyzed. The etiology of stroke was divided into cardioembolism, large artery atherosclerosis, and active cancer groups. All selected thrombi were subjected to hematoxylin and eosin staining. The percentages of fibrin/platelets, red blood cells, and white blood cells within a thrombus were quantified.
One-hundred fifty-two patients (active cancer, 19; cardioembolism, 107; large artery atherosclerosis, 26) were included. Thrombi from the active cancer group exhibited a higher fibrin/platelet composition than did those from the cardioembolism and large artery atherosclerosis groups (median, 85.7% versus 43.9% and 42.5%; <0.001). Fibrin/platelet composition was the only independent factor (odds ratio, 1.05 [95% CI, 1.02-1.08]) in differentiating cancer-related stroke from stroke caused by cardioembolism and large artery atherosclerosis. A fibrin/platelet proportion of ≥65% accurately predicted cancer-related stroke (area under the curve, 0.84; <0.001).
In thrombi retrieved from patients undergoing endovascular treatment, a high fibrin/platelet composition was a probable indicator of cancer-related stroke.
我们旨在研究经血管内治疗的急性缺血性脑卒中患者取栓得到的血栓组织病理检查是否可以区分出与癌症相关的脑卒中与其他病因。
分析接受血管内治疗的患者的血栓。脑卒中的病因分为心源性栓塞、大动脉粥样硬化和活动性癌症组。所有选择的血栓均进行苏木精-伊红染色。定量计算血栓内纤维蛋白/血小板、红细胞和白细胞的百分比。
共纳入 152 例患者（活动性癌症 19 例，心源性栓塞 107 例，大动脉粥样硬化 26 例）。与心源性栓塞和大动脉粥样硬化组相比，活动性癌症组的血栓中纤维蛋白/血小板的成分更高（中位数，85.7%比 43.9%和 42.5%；<0.001）。纤维蛋白/血小板成分是区分癌症相关脑卒中与心源性栓塞和大动脉粥样硬化引起的脑卒中的唯一独立因素（比值比，1.05[95%置信区间，1.02-1.08]）。纤维蛋白/血小板比例≥65%可准确预测癌症相关脑卒中（曲线下面积，0.84；<0.001）。
在接受血管内治疗的患者取栓得到的血栓中，高纤维蛋白/血小板成分可能是与癌症相关脑卒中的一个指标。
