Department of Biomedical Engineering, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
J Biomech. 2021 Dec 2;129:110816. doi: 10.1016/j.jbiomech.2021.110816. Epub 2021 Oct 15.
Thrombus composition and mechanical properties significantly impact the ease and outcomes of thrombectomy procedures in patients with acute ischemic stroke. A wide variation exists in the composition of thrombi between patients. If a relationship can be determined between the composition of a thrombus and its mechanical behaviour, as well as between the composition of a thrombus and its radiological imaging characteristics, then there is the potential to personalise thrombectomy treatment based on each individual thrombus. This review aims to give an overview of the current literature addressing this issue. Here, we present a scoping review detailing associations between thrombus composition, mechanical behaviour and radiological imaging characteristics. We conducted two searches 1) on the association between thrombus composition and the mechanical behaviour of the tissue and 2) on the association between radiological imaging characteristics and thrombus composition in the acute stroke setting. The review suggests that higher fibrin and lower red blood cell (RBC) content contribute to stiffer thrombi independent of the loading mode. Further, platelet-contracted thrombi are stiffer than non-contracted compositional counterparts. Fibrin content contributes to the elastic portion of viscoelastic behaviour while RBC content contributes to the viscous portion. It is possible to identify fibrin-rich or RBC-rich thrombi with computed tomography and magnetic resonance imaging vessel signs. Standardisation is required to quantify the association between thrombus density on non-contrast computed tomography and the RBC content. The characterisation of the thrombus fibrin network has not been addressed so far in radiological imaging but may be essential for the prediction of device-tissue interactions and distal thrombus embolization. The association between platelet-driven clot contraction and radiological imaging characteristics has not been explicitly investigated. However, evidence suggests that perviousness may be a marker of clot contraction.
血栓的组成和力学性质显著影响急性缺血性脑卒中患者血栓切除术的难易程度和结果。患者之间的血栓组成存在很大差异。如果能够确定血栓组成与其力学行为之间，以及血栓组成与其放射影像学特征之间的关系，那么就有可能根据每个血栓的特点来制定个性化的血栓切除术治疗方案。本综述旨在概述目前解决这一问题的文献。在这里，我们详细介绍了血栓组成、力学行为和放射影像学特征之间的关联。我们进行了两次检索：1）血栓组成与组织力学行为之间的关联，以及 2）急性脑卒中环境下放射影像学特征与血栓组成之间的关联。综述表明，较高的纤维蛋白和较低的红细胞（RBC）含量会导致血栓变硬，而与加载方式无关。此外，血小板收缩的血栓比非收缩的组成物更硬。纤维蛋白含量有助于粘弹性行为的弹性部分，而 RBC 含量有助于粘性部分。可以通过计算机断层扫描和磁共振成像血管征象来识别富含纤维蛋白或富含 RBC 的血栓。需要标准化来量化非增强 CT 上的血栓密度与 RBC 含量之间的关联。到目前为止，在放射影像学中还没有涉及对血栓纤维蛋白网络的特征描述，但这对于预测器械与组织的相互作用和远端血栓栓塞可能至关重要。血小板驱动的凝块收缩与放射影像学特征之间的关联尚未明确研究。然而，有证据表明，通透性可能是凝块收缩的标志物。
