Ikenberg Benno, Boeckh-Behrens Tobias, Maegerlein Christian, Härtl Johanna, Hernandez Petzsche Moritz, Zimmer Claus, Wunderlich Silke, Berndt Maria
Department of Neurology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Front Neurol. 2022 Mar 11;13:824792. doi: 10.3389/fneur.2022.824792. eCollection 2022.
Despite sufficient oral anticoagulation (OAC) to prevent cardioembolism, some patients suffer from cerebral ischemic strokes of suspected cardioembolic origin. Reasons for that are not clarified yet. In certain cases, the suspected cardioembolic origin of stroke is questioned. This study aimed to understand the thrombi origin and pathophysiology in patients suffering from stroke despite OAC by the analysis of histologic thrombus composition and imaging characteristics.
On two distinct cohorts, we retrospectively analyzed histologic ( = 92) and imaging features ( = 64), i.e., thrombus perviousness in admission CT imaging, of cerebral thrombi retrieved by the endovascular treatment for a large vessel occlusion of the anterior circulation. In each group, patients with non-cardioembolic strokes and suspected cardioembolic strokes with or without anticoagulation were compared.
Fibrin/platelet content of suspected cardioembolic thrombi (mean/SD 57.2% ± 13) is higher than in non-cardioembolic thrombi (48.9% ± 17; = 0.01). In suspected cardioembolic thrombi, the fibrin/platelet content does not differ in the subgroups of patients with (57.3% ± 13) and without prior OAC treatment (56.6% ±13; = 0.8), both with higher values than non-cardioembolic thrombi. Thrombus perviousness (ε) of suspected cardioembolic OAC thrombi (mean/SD: 0.09 ± 0.06) differs significantly from non-cardioembolic thrombi (0.02 ± 0.02; < 0.001). Further, ε is higher in suspected cardioembolic thrombi with OAC than in cardioembolic thrombi without OAC (0.06 ± 0.03; = 0.04) and with insufficient OAC (0.04 ± 0.02; = 0.07).
Thrombi of the suspected cardioembolic origin of patients with prior OAC do not differ in their histologic composition from those without prior OAC, but both differ from non-cardioembolic thrombi. These histologic results make a non-cardioembolic etiology for strokes despite prior OAC rather unlikely but favor other reasons for these ischemic events. Perviousness assessment reinforces the histologic findings, with additional information about the OAC thrombi, which present with higher perviousness. This suggests that OAC would not affect the relative histologic thrombus composition but may alter the microstructure, as reflected by perviousness.
尽管进行了充分的口服抗凝治疗（OAC）以预防心源性栓塞，但仍有一些患者发生了疑似心源性栓塞起源的脑缺血性卒中。其原因尚未明确。在某些情况下，卒中的心源性栓塞起源受到质疑。本研究旨在通过分析组织学血栓成分和影像学特征，了解接受OAC治疗的卒中患者血栓的起源和病理生理学。
在两个不同的队列中，我们回顾性分析了通过血管内治疗前循环大血管闭塞所获取的脑内血栓的组织学（n = 92）和影像学特征（n = 64），即入院CT成像中的血栓通透性。在每组中，对非心源性栓塞性卒中和疑似心源性栓塞性卒中（无论是否接受抗凝治疗）的患者进行了比较。
疑似心源性栓塞性血栓的纤维蛋白/血小板含量（均值/标准差 57.2% ± 13）高于非心源性栓塞性血栓（48.9% ± 17；P = 0.01）。在疑似心源性栓塞性血栓中，接受过OAC治疗的患者亚组（57.3% ± 13）和未接受过OAC治疗的患者亚组（56.6% ± 13；P = 0.8）的纤维蛋白/血小板含量无差异，两者均高于非心源性栓塞性血栓。疑似心源性栓塞性OAC血栓的血栓通透性（ε）（均值/标准差：0.09 ± 0.06）与非心源性栓塞性血栓（0.02 ± 0.02；P < 0.001）有显著差异。此外，接受OAC治疗的疑似心源性栓塞性血栓的ε高于未接受OAC治疗的心源性栓塞性血栓（0.06 ± 0.03；P = 0.04）和OAC治疗不足的心源性栓塞性血栓（0.04 ± 0.02；P = 0.07）。
接受过OAC治疗的患者疑似心源性栓塞起源的血栓，其组织学组成与未接受过OAC治疗的患者的血栓并无差异，但两者均与非心源性栓塞性血栓不同。这些组织学结果表明，尽管接受过OAC治疗，卒中的非心源性栓塞病因可能性较小，但更倾向于这些缺血事件存在其他原因。通透性评估强化了组织学结果，并提供了有关OAC血栓的额外信息，这些血栓的通透性更高。这表明OAC不会影响血栓的相对组织学组成，但可能会改变微观结构，如通透性所反映的那样。
