Sugiyama Natsuki, Hasegawa Hiroshi, Kudo Kentaro, Miyahara Ryo, Saito Rikizo, Maruki Chikashi, Takase Masaru, Kondo Akihide, Oishi Hidenori
Department of Neurosurgery, Koshigaya Municipal Hospital, Koshigaya, Saitama, Japan.
Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
NMC Case Rep J. 2022 Jul 27;9:225-230. doi: 10.2176/jns-nmc.2022-0095. eCollection 2022.
There are only a few case reports in which cholesterol crystals were found in the thrombus retrieved by mechanical thrombectomy for cryptogenic stroke, leading to a definitive diagnosis. We herein report a case of aortogenic embolic stroke diagnosed by the presence of rich cholesterol crystals in the retrieved thrombus and review the previously reported cases. A woman in her 80s was transferred as an emergency due to consciousness disturbance, right conjugate deviation, and severe left hemiparesis. Magnetic resonance imaging showed occlusion of the right middle cerebral artery (MCA) and acute infarction in the territory. The MCA was recanalized by thrombectomy using an aspiration catheter and stent retriever, and the symptoms improved. Although the physiological examination did not detect the embolic source during hospitalization, pathological examination of the thrombus revealed atheroma with numerous cholesterol crystal clefts and intermixing of fibrin. Contrast-enhanced computed tomography performed based on the pathological results showed atheromatous lesions in the aortic arch as the embolic source. As a subsequent treatment, medications of a strong statin and an antiplatelet agent were continued, and the patient had no recurrence. The finding that the retrieved thrombus is a simple atheroma containing cholesterol crystals with poor hemocytes suggests embolism due to plaque rupture. Pathological examination of the thrombus obtained by thrombectomy is one of the useful diagnostic approaches for stroke etiology and the determination of its treatment.
在因不明原因卒中接受机械取栓术取出的血栓中发现胆固醇结晶并据此做出明确诊断的病例报告仅有少数几例。我们在此报告一例因取出的血栓中存在大量胆固醇结晶而诊断为主动脉源性栓塞性卒中的病例，并回顾此前报道的病例。一名80多岁的女性因意识障碍、右侧同向偏斜和严重左侧偏瘫作为急诊入院。磁共振成像显示右侧大脑中动脉（MCA）闭塞及该区域急性梗死。使用抽吸导管和支架取栓器对MCA进行了再通，症状有所改善。尽管住院期间体格检查未发现栓子来源，但血栓的病理检查显示有含大量胆固醇结晶裂隙和纤维蛋白混杂的动脉粥样硬化斑块。根据病理结果进行的增强计算机断层扫描显示主动脉弓处的动脉粥样硬化病变为栓子来源。作为后续治疗，继续使用强效他汀类药物和抗血小板药物，患者未再复发。取出的血栓是含有胆固醇结晶且血细胞较少的单纯动脉粥样硬化斑块这一发现提示因斑块破裂导致栓塞。对取栓术获得的血栓进行病理检查是卒中病因诊断及其治疗决策的有用诊断方法之一。
