Department of Neurosurgery, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, PR China.
Department of Radiology, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China.
Clin Neurol Neurosurg. 2021 Aug;207:106804. doi: 10.1016/j.clineuro.2021.106804. Epub 2021 Jul 9.
Clot composition could impact recanalization outcomes of thrombectomy, and preoperative imaging markers may help know about the histological components of thrombus.
Consecutive patients who underwent thrombectomy from June 2017 to December 2019 were reviewed. The mean Hounsfield unit (HU) of thrombus (aHU) and contralateral artery (cHU) were recorded based on non-enhanced CT. The relative thrombus density was calculated (dHU=aHU-cHU). Hyperdense artery sign (HAS) was identified if dHU≥ 4HU. The clot perviousness was evaluated via thrombus attenuation increase (δHU) on contrast-enhanced CT compared to non-enhanced CT. Pervious clots were identified when δHU≥ 11HU. Tissue quantification for thrombus was based on Martius Scarlet Blue staining, using the Orbit Imaging Analysis Software. Spearman rank correlations was used to detect the association between imaging markers and clot composition. The differences in clinical characteristics were compared according to the presence of HAS or pervious clots.
Fifty-three patients were included. The dHU was positively correlated with erythrocyte fractions (r = 0.337, p = 0.014), while there was no significant association between aHU and erythrocyte components (r = 0.146, p = 0.296). HAS (+) patients showed a comparable proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3 (94.6% vs. 87.5%, p = 0.740) and modified Rankin Scale score (mRS) 0-2 (35.1% vs. 56.3%, p = 0.152) compared with those HAS (-). Forty-seven cases were available for the analysis of clot perviousness. Clot perviousness was negatively associated with platelet fractions (r = -0.577, p < 0.001). Patients with pervious clots also showed a comparable proportion of mTICI 2b-3 (86.2% vs. 100%, p = 0.283) and mRS 0-2 (37.9% vs. 50.0%, p = 0.416) compared with impervious clots.
This study suggests that relative thrombus density was positively correlated with erythrocyte fractions, while clot perviousness showed a negative relationship with platelet components. Yet, the presence of HAS or pervious clots did not show significant associations with recanalization and clinical outcomes. The conclusions should be drawn with caution.
血栓的组成成分可能会影响血栓切除术的再通效果，术前影像学标志物可能有助于了解血栓的组织学成分。
回顾 2017 年 6 月至 2019 年 12 月期间接受血栓切除术的连续患者。根据非增强 CT 记录血栓（aHU）和对侧动脉（cHU）的平均亨氏单位（HU）。计算相对血栓密度（dHU=aHU-cHU）。如果 dHU≥4HU，则确定高密度动脉征（HAS）。通过对比增强 CT 与非增强 CT 比较评估血栓衰减增加（δHU）来评估血栓的通透性。当 δHU≥11HU 时，确定可透性血栓。使用 Martius Scarlet Blue 染色对血栓进行组织定量，使用 Orbit Imaging Analysis 软件进行分析。采用 Spearman 秩相关检验检测影像学标志物与血栓成分之间的相关性。根据 HAS 或可透性血栓的存在情况比较临床特征的差异。
共纳入 53 例患者。dHU 与红细胞分数呈正相关（r=0.337，p=0.014），而 aHU 与红细胞成分无显著相关性（r=0.146，p=0.296）。HAS（+）患者的改良脑梗死溶栓治疗（mTICI）2b-3（94.6% vs. 87.5%，p=0.740）和改良 Rankin 量表评分（mRS）0-2（35.1% vs. 56.3%，p=0.152）的比例与 HAS（-）患者相当。对 47 例可透性血栓进行分析。血栓可透性与血小板分数呈负相关（r=-0.577，p<0.001）。可透性血栓患者的 mTICI 2b-3（86.2% vs. 100%，p=0.283）和 mRS 0-2（37.9% vs. 50.0%，p=0.416）的比例与不透性血栓相当。
本研究表明，相对血栓密度与红细胞分数呈正相关，而血栓通透性与血小板成分呈负相关。然而，HAS 或可透性血栓的存在与再通效果和临床结局无显著相关性。结论应谨慎得出。
