Baek Jang-Hyun
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Neurointervention. 2024 Jul;19(2):65-73. doi: 10.5469/neuroint.2024.00087. Epub 2024 Apr 4.
Endovascular thrombectomy is the primary treatment for acute intracranial vessel occlusion and significantly improves recanalization success rate. However, achieving optimal recanalization remains a challenge. The histopathological components of thrombus composition play a crucial role in determining endovascular outcomes. This review aimed to consolidate the recent evidence on the impact of thrombus composition on mechanical properties and endovascular outcomes. The relationship between thrombus composition and mechanical properties was significant, with fibrin and/or platelet-rich thrombi being stiff, tough, elastic, and less deformable; fibrin-rich thrombi were sticky and had higher friction with the vessel wall. Erythrocyte composition was positively associated with successful recanalization, whereas lower platelet composition was associated with specific outcomes, such as the first-pass effect and complete recanalization. The number of thrombectomy device passes was possibly related to erythrocyte, platelet, and fibrin composition, with a smaller number of passes associated with erythrocyte-rich thrombi. Procedural time was consistently related to thrombus composition, with shorter times observed for erythrocyte-rich thrombi. The relationship between thrombus composition and secondary embolism remains inconclusive. Understanding the role of thrombus composition in endovascular outcomes is crucial to optimize stroke treatment. Although evidence suggests a link between thrombus composition and mechanical properties, further research is needed to establish stronger correlations and to reduce study variations. Exploring non-traditional thrombus components such as leukocytes and neutrophil extracellular traps is vital. Thrombus imaging could provide a practical solution for predicting thrombus composition before endovascular procedures. This review highlights the importance of thrombus composition for enhancing endovascular stroke treatment strategies.
血管内血栓切除术是急性颅内血管闭塞的主要治疗方法，可显著提高再通成功率。然而，实现最佳再通仍然是一项挑战。血栓成分的组织病理学组成在决定血管内治疗结果方面起着关键作用。本综述旨在整合近期关于血栓成分对机械性能和血管内治疗结果影响的证据。血栓成分与机械性能之间的关系显著，富含纤维蛋白和/或血小板的血栓坚硬、坚韧、有弹性且不易变形；富含纤维蛋白的血栓粘性大，与血管壁的摩擦力更高。红细胞成分与成功再通呈正相关，而较低的血小板成分与特定结果相关，如首过效应和完全再通。血栓切除术器械操作次数可能与红细胞、血小板和纤维蛋白成分有关，操作次数越少与富含红细胞的血栓相关。手术时间始终与血栓成分相关，富含红细胞的血栓手术时间较短。血栓成分与继发性栓塞之间的关系仍无定论。了解血栓成分在血管内治疗结果中的作用对于优化中风治疗至关重要。尽管有证据表明血栓成分与机械性能之间存在联系，但仍需要进一步研究以建立更强的相关性并减少研究差异。探索白细胞和中性粒细胞胞外陷阱等非传统血栓成分至关重要。血栓成像可为血管内手术前预测血栓成分提供切实可行的解决方案。本综述强调了血栓成分对加强血管内中风治疗策略的重要性。
