Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
J Clin Neurosci. 2024 Jun;124:54-59. doi: 10.1016/j.jocn.2024.04.013. Epub 2024 Apr 20.
There is conflicting data on whether clot retrieved from mechanical thrombectomy can predict stroke etiology or the success of recanalization. We aimed to analyse the relation between thrombus histology and stroke aetiology as well as recanalization.
Histopathological analysis of clots retrieved from patients with acute ischemic stroke and large vessel occlusion was done. Quantification of the amount of fibrin, red blood cells(RBC), platelets and white blood cells (WBC) in the clots were done. The clinical, imaging data and recanalization parameters were collected. The correlation between clot composition and stroke etiology as well as recanalization were analysed.
Of the 77 patients, the mean age was 58. 67 ± 12.96 years. The stroke etiology were cardioembolism 44(57.1 %), large artery atherosclerosis 13(16.8 %), other determined aetiology 4(5.1 %) and undetermined in 16(20.7 %) patients. There was no significant correlation between the proportions of RBC-rich, platelet-rich and fibrin-rich thrombi and the stroke etiology. The susceptibility vessel sign was associated with RBC-rich clot(92.3 % vs 7.7 %, p = .03). All RBC-rich clots(100 %) had good recanalization(p = .05). Platelet-rich clots needed less number of passes(64.7 % vs 35.3 %, p = .006) and reduced groin puncture to recanalization time(87.9 % vs 12.1 %, p = .033). WBC-rich clots required lesser number of passes(57.5 % vs 42.5 %, P = .044). In multivariate analysis, WBC-rich clots (OR 0.230, CI 0.07-0.78, p = .018) showed an independent association with reduced recanalization attempts, while platelet-rich clots showed reduced recanalization time(OR 0.09, CI 0.01-0.63, p = .016).
There was no correlation between thrombus histology and the etiological stroke subtype. However, clot composition predicted the degree of recanalization and number of passes.
关于从机械血栓切除术取出的血栓是否可以预测卒中病因或再通的成功率，目前存在相互矛盾的数据。我们旨在分析血栓组织学与卒中病因以及再通之间的关系。
对急性缺血性卒中且存在大血管闭塞患者的血栓进行组织病理学分析。对血栓中的纤维蛋白、红细胞（RBC）、血小板和白细胞（WBC）的数量进行量化。收集临床、影像数据和再通参数。分析血栓成分与卒中病因以及再通之间的相关性。
77 例患者中，平均年龄为 58.67±12.96 岁。卒中病因分别为心源性栓塞 44 例（57.1%）、大动脉粥样硬化 13 例（16.8%）、其他确定病因 4 例（5.1%）和 16 例（20.7%）病因不明。RBC 丰富、血小板丰富和纤维蛋白丰富血栓的比例与卒中病因之间无显著相关性。易损血管征与 RBC 丰富血栓相关（92.3%比 7.7%，p=0.03）。所有 RBC 丰富的血栓（100%）均具有良好的再通（p=0.05）。血小板丰富的血栓需要较少的通过次数（64.7%比 35.3%，p=0.006）和缩短股动脉穿刺至再通时间（87.9%比 12.1%，p=0.033）。WBC 丰富的血栓需要较少的通过次数（57.5%比 42.5%，P=0.044）。多变量分析显示，WBC 丰富的血栓（OR 0.230，CI 0.07-0.78，p=0.018）与减少再通尝试独立相关，而血小板丰富的血栓则缩短了再通时间（OR 0.09，CI 0.01-0.63，p=0.016）。
血栓组织学与卒中病因亚型之间无相关性。然而，血栓成分预测了再通程度和通过次数。
