Schwarz Ghil, Rizzo Angelo Cascio, Di Como Martina, Cervo Amedeo, Macera Antonio, Pero Guglielmo Carlo, Aquilano Maria Costanza, dell'Acqua Beatrice, Bacigaluppi Marco, Ruggieri Francesco, Chieregato Arturo, Bonoldi Emanuela, Piano Mariangela, Sessa Maria, Agostoni Elio Clemente
Department of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Department of Hematology, Oncology and Molecular Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Stroke Res Treat. 2025 Jun 23;2025:8650226. doi: 10.1155/srat/8650226. eCollection 2025.
Histological analysis of thrombi can enhance the understanding of pathophysiology. We aimed to analyze EVT-retrieved thrombi in cerebral venous thrombosis (CVT), compare them with acute ischemic stroke (AIS) thrombi, and correlate their composition with CT density. Retrospective case-series, including five CVT and 10 AIS cases treated with EVT. Thrombus sections were stained with hematoxylin and eosin; Picro Mallory for RBCs, fibrin, and collagen; and Prussian Blue for iron plus immunohistochemical staining with anti-CD61 (platelets), anti-MPO (neutrophils), anti-CD3 (T-cells), anti-CD20 (B-cells), anti-CD34 (endothelial cells), anti-CD68 (macrophages), and anti-citH3 (NETs). Thrombus components were quantified (Orbit) and expressed as a percentage of total area. The CVT-thrombus relative density (rHU) was calculated as HU thrombus/HU contralateral. All CVT cases showed extensive thrombosis. Four patients had prior anticoagulation, and four had rHU > 1.00 with CT hyperdensity. The etiologies were heterogeneous. CVT thrombi were rich in red blood cells and displayed variable histological features, including signs of early organization. Compared to arterial thrombi, venous thrombi exhibited larger size (surface area 185.6 mm [IQR 83.0-237.9] vs. 21.8 mm [IQR 8.8-77.8]; = 0.028) and lower fibrin content (16.6% [IQR 13.9-31.5] vs. 46.5% [IQR 25.1-49.5]; = 0.036), with no other significant differences in composition. Low fibrin content and high RBC-to-fibrin ratio ( -0.9 and R 0.9, respectively; = 0.047 for both) showed a significant correlation with rHU. Our exploratory study first shows that CVT thrombi are larger than AIS thrombi, with higher RBC content and lower fibrin, matching CT density. These findings enhance the understanding of CVT pathophysiology but need validation.
血栓的组织学分析有助于加深对病理生理学的理解。我们旨在分析脑静脉血栓形成（CVT）中经血管内血栓切除术（EVT）取出的血栓，将其与急性缺血性卒中（AIS）血栓进行比较，并将其成分与CT密度相关联。回顾性病例系列研究，包括5例接受EVT治疗的CVT患者和10例AIS患者。血栓切片用苏木精和伊红染色；用苦味酸马洛里染色法检测红细胞、纤维蛋白和胶原蛋白；用普鲁士蓝染色法检测铁，并进行抗CD61（血小板）、抗MPO（中性粒细胞）、抗CD3（T细胞）、抗CD20（B细胞）、抗CD34（内皮细胞）、抗CD68（巨噬细胞）和抗瓜氨酸化组蛋白H3（中性粒细胞胞外陷阱，NETs）的免疫组织化学染色。对血栓成分进行定量分析（使用Orbit软件），并表示为总面积的百分比。计算CVT血栓相对密度（rHU），即血栓HU值/对侧HU值。所有CVT病例均显示广泛血栓形成。4例患者曾接受抗凝治疗，4例rHU>1.00且CT呈高密度。病因多种多样。CVT血栓富含红细胞，并表现出不同的组织学特征，包括早期机化迹象。与动脉血栓相比，静脉血栓体积更大（表面积185.6mm[四分位间距83.0 - 237.9] vs. 21.8mm[四分位间距8.8 - 77.8]；P = 0.028），纤维蛋白含量更低（16.6%[四分位间距13.9 - 31.5] vs. 46.5%[四分位间距25.1 - 49.5]；P = 0.036），在成分上无其他显著差异。低纤维蛋白含量和高红细胞与纤维蛋白比值（分别为 -0.9和R 0.9；两者P = 0.047）与rHU显著相关。我们的探索性研究首次表明，CVT血栓比AIS血栓更大，红细胞含量更高，纤维蛋白含量更低，与CT密度相符。这些发现有助于加深对CVT病理生理学的理解，但需要进一步验证。
