Juega Jesus, Requena Manuel, Piñana Carlos, Rodriguez Maite, Camacho Jessica, Vidal Marta, Moliné Teresa, Serna Garazi, Palacio-Garcia Carlos, Rubiera Marta, Garcia-Tornel Alvaro, Rodriguez-Villatoro Noelia, Rodriguez-Luna David, Muchada Marian, Olive Gadea Marta, Rizzo Federica, Rodrigo-Gisbert Marc, Lazaro Carlos, Hernandez David, de Dios Lascuevas Marta, Diana Francesco, Dorado Laura, Hernández-Pérez María, Quesada Helena, Cardona Portela Pere, De La Torre Carolina, Ramon-Y-Cajal Santiago, Tomasello Alejandro, Ribo Marc, Molina Carlos A, Pagola Jorge
Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital. Autonomous University of Barcelona. Vall d'Hebron Research Institute, Barcelona, Spain
Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital. Autonomous University of Barcelona. Vall d'Hebron Research Institute, Barcelona, Spain.
J Neurointerv Surg. 2024 May 30;17(5):525-529. doi: 10.1136/jnis-2024-021654.
The impact of thrombolytics directed towards different thrombus components regarding site of occlusion in combination with mechanical thrombectomy (MT) to achieve endovascular complete recanalization is unclear.
Retrospective analysis of a prospective database in two stroke centers. Intracranial thrombi retrieved by MT were analyzed using hematoxylin-eosin staining for fibrin and red blood cell proportions, and CD61 immunostaining for platelets proportion in thrombus (PLTPT) assessment. Thrombi composition, baseline variables, etiology, treatment features and occlusion location were analyzed.
Overall, 221 patients completed the per protocol analysis and 110 cases achieved a final expanded Thrombolysis in Cerebral Infarction (eTICI) 3 (49%) of which 70 were MT (32%) by first pass effect (FPE). Thrombi from medium distal vessel occlusions had higher PLTPT compared with thrombi from proximal large vessel occlusions (68% vs 61%, P=0.026). In particular, middle cerebral artery M2-M3 segment thrombi had the highest PLTPT (70%), and basilar artery thrombi the lowest PLTPT (41%). After logistic regression analysis adjusted for occlusion location and intravenous fibrinolysis, lower baseline National Institutes of Health Stroke Scale score (adjusted OR (aOR) 0.95, 95% CI 0.913 to 0.998) and PLTPT (aOR 0.97, 95% CI 0.963 to 0.993) were independently associated with FPE. Fewer MT passes (aOR 0.67, 95% CI 0.538 to 0.842) and platelet poor thrombus (<62% PLTPT; aOR 2.39, 95% CI 1.288 to 4.440) were independently associated with final eTICI 3.
Occlusion location might be a surrogate parameter for thrombus composition. Platelet poor clots and fewer MT passes were independently associated with complete endovascular recanalization. Clinical trials testing the benefits of combining selective intra-arterial platelet antagonists with MT to improve endovascular outcomes are warranted.
针对不同血栓成分并结合机械取栓术（MT）以实现血管内完全再通的溶栓药物对闭塞部位的影响尚不清楚。
对两个卒中中心的前瞻性数据库进行回顾性分析。使用苏木精 - 伊红染色分析MT取出的颅内血栓的纤维蛋白和红细胞比例，以及使用CD61免疫染色评估血栓中的血小板比例（PLTPT）。分析血栓组成、基线变量、病因、治疗特征和闭塞位置。
总体而言，221例患者完成了符合方案分析，110例患者最终达到扩展的脑梗死溶栓（eTICI）3级（49%），其中70例（32%）通过首次通过效应（FPE）实现MT。与近端大血管闭塞的血栓相比，中远端血管闭塞的血栓具有更高的PLTPT（68%对61%，P = 0.026）。特别是，大脑中动脉M2 - M3段血栓的PLTPT最高（70%），基底动脉血栓的PLTPT最低（41%）。在对闭塞位置和静脉溶栓进行校正的逻辑回归分析后，较低的基线美国国立卫生研究院卒中量表评分（校正比值比（aOR）0.95，95%置信区间0.913至0.998）和PLTPT（aOR 0.97，95%置信区间0.963至0.993）与FPE独立相关。较少的MT次数（aOR 0.67，95%置信区间0.538至0.842）和血小板含量低的血栓（<62% PLTPT；aOR 2.39，95%置信区间1.288至4.440）与最终的eTICI 3级独立相关。
闭塞位置可能是血栓组成的替代参数。血小板含量低的血栓和较少的MT次数与血管内完全再通独立相关。有必要进行临床试验，测试将选择性动脉内血小板拮抗剂与MT联合使用以改善血管内治疗结果的益处。
