Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
Graduate School of Peking Union Medical College, Beijing, China.
BMC Neurol. 2021 Oct 13;21(1):398. doi: 10.1186/s12883-021-02428-w.
The significance of carotid webs (CaWs) in ischemic stroke is becoming acknowledged. Histological features of clot composition in situ and secondary cerebrovascular embolized thrombi caused by CaW have not been described concurrently. Understanding clots' histological composition is essential for understanding the pathophysiology of clot formation in CaW.
A 50-year-old male patient with acute ischemic stroke, which was believed to be caused by ipsilateral CaW, was admitted to the hospital. Mechanical thrombectomy was used to retrieve thromboemboli from the middle cerebral artery. One month thereafter, the patient underwent carotid endarterectomy, and in situ CaW thrombi were retrieved. Histological analysis by hematoxylin and eosin staining revealed that histopathologic embolized thrombi appeared as typical mixed thrombi, 46.03% fibrin/platelet ratio, 48.12% RBCs, and 5.85% white blood cells. In situ thrombi had a higher fibrin/platelet ratio (68.0%), fewer RBCs (17.2%), and 14.8% white blood cells.
The histopathology of large vessel occlusion stroke embolized thrombi by CaW is similar to that of other stroke etiologies. However, the clot composition of embolized thrombi significantly differs from that of in situ thrombi. CaW's in situ thrombi showed predominantly fibrin, and embolized thrombi had equivalent contents of red blood cells and fibrin/platelets. Histopathological differences between in situ and embolized thrombi suggest new research directions for the etiology of embolization. Further studies are required to confirm these results.
颈动脉血管壁（CaW）在缺血性卒中中的意义正逐渐得到认可。CaW 引起的原位血栓成分和继发性脑血管栓塞血栓的组织学特征尚未同时描述。了解血栓的组织学成分对于理解 CaW 中血栓形成的病理生理学至关重要。
一名 50 岁男性患者因急性缺血性卒中入院，据信该卒中由同侧 CaW 引起。采用机械血栓切除术从中动脉中取出血栓栓塞物。一个月后，患者接受了颈动脉内膜切除术，并取出了原位 CaW 血栓。苏木精和伊红染色的组织学分析显示，组织病理学栓塞血栓表现为典型的混合血栓，纤维蛋白/血小板比为 46.03%，红细胞为 48.12%，白细胞为 5.85%。原位血栓的纤维蛋白/血小板比（68.0%）更高，红细胞（17.2%）和白细胞（14.8%）较少。
CaW 引起的大血管闭塞性卒中栓塞性血栓的组织病理学与其他卒中病因相似。然而，栓塞性血栓的血栓成分与原位血栓明显不同。CaW 原位血栓主要含有纤维蛋白，而栓塞性血栓的红细胞和纤维蛋白/血小板含量相等。原位和栓塞性血栓之间的组织学差异提示了栓塞病因的新研究方向。需要进一步的研究来证实这些结果。
