Department of Radiology and Nuclear Medicine (N.K., P.R.W.S.v.S., A.C.G.M.v.E.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Department of Neurology (N.K., D.W.J.D., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Stroke. 2021 Aug;52(8):2510-2517. doi: 10.1161/STROKEAHA.120.033527. Epub 2021 Jun 3.
Mechanical properties of thromboemboli play an important role in the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke. However, very limited data on mechanical properties of human stroke thrombi are available. We aimed to mechanically characterize thrombi retrieved with EVT, and to assess the relationship between thrombus composition and thrombus stiffness.
Forty-one thrombi from 19 patients with acute stroke who underwent EVT between July and October 2019 were mechanically analyzed, directly after EVT. We performed unconfined compression experiments and determined tangent modulus at 75% strain (Et75) as a measure for thrombus stiffness. Thrombi were histologically analyzed for fibrin/platelets, erythrocytes, leukocytes, and platelets, and we assessed the relationship between histological components and Et75 with univariable and multivariable linear mixed regression.
Median Et75 was 560 (interquartile range, 393–1161) kPa. In the multivariable analysis, fibrin/platelets were associated with increased Et75 (aβ, 9 [95% CI, 5 to 13]) kPa, erythrocytes were associated with decreased Et75% (aβ, −9 [95% CI, −5 to −13]) kPa. We found no association between leukocytes and Et75. High platelet values were strongly associated with increased Et75 (aβ, 56 [95% CI, 38–73]).
Fibrin/platelet content of thrombi retrieved with EVT for acute ischemic stroke is strongly associated with increased thrombus stiffness. For thrombi with high platelet values, there was a very strong relationship with thrombus stiffness. Our data provide a basis for future research on the development of next-generation EVT devices tailored to thrombus composition.
血栓的力学特性在急性缺血性脑卒中的血管内血栓切除术（EVT）疗效中起着重要作用。然而，目前关于人类脑卒中血栓的力学特性的资料非常有限。本研究旨在对 EVT 取出的血栓进行力学特性分析，并评估血栓成分与血栓硬度之间的关系。
2019 年 7 月至 10 月间，19 名急性脑卒中患者接受 EVT 治疗，我们直接在 EVT 后对 41 个血栓进行机械分析。我们进行了无约束压缩实验，并以 75%应变时的切向模量（Et75）作为衡量血栓硬度的指标。对血栓进行纤维蛋白/血小板、红细胞、白细胞和血小板的组织学分析，并通过单变量和多变量线性混合回归评估组织学成分与 Et75 的关系。
中位数 Et75 为 560（四分位距，393～1161）kPa。在多变量分析中，纤维蛋白/血小板与 Et75 的增加有关（β值为 9 [95%置信区间，5 至 13] kPa），红细胞与 Et75 的降低有关（β值为-9 [95%置信区间，-5 至-13] kPa）。白细胞与 Et75 之间无相关性。血小板值高与 Et75 的增加密切相关（β值为 56 [95%置信区间，38～73]）。
EVT 治疗急性缺血性脑卒中取出的血栓中的纤维蛋白/血小板含量与血栓硬度的增加密切相关。对于血小板值高的血栓，与血栓硬度的关系非常强。我们的数据为未来开发针对血栓成分的新一代 EVT 设备的研究提供了依据。
