Mol Kevin, Mulder Inge A, van Bavel Ed
Biomedical Engineering and Physics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, the Netherlands.
Acta Physiol (Oxf). 2025 Oct;241(10):e70098. doi: 10.1111/apha.70098.
The cerebral circulation is continuously challenged by intravascular micrometer-sized particles that become trapped microvascular-emboli. These particles may include micro-thrombi, stiffened erythrocytes, and leukocytes, while also fat particles, air, and microplastics may cause microvascular embolism.
In this narrative review, we discuss these embolization processes and their acute and chronic consequences. These relate to the local flow interruption as well as the direct interaction with the endothelium. In addition, we address the clearing processes, including local thrombolysis and extravasation, or angiophagy, of the emboli.
A continuous balance exists between embolic events and their resolution under normal conditions. Increased micro-embolic rates, as occur in e.g., atrial fibrillation, or decreased clearing, possibly related to endothelial cell dysfunction, disturb this balance. This could lead to continuing loss of capillaries, micro-infarcts, and cognitive decline.
脑循环不断受到血管内微米级颗粒的挑战，这些颗粒会形成微血管栓塞。这些颗粒可能包括微血栓、硬化红细胞和白细胞，同时脂肪颗粒、空气和微塑料也可能导致微血管栓塞。
在本叙述性综述中，我们讨论了这些栓塞过程及其急性和慢性后果。这些后果与局部血流中断以及与内皮的直接相互作用有关。此外，我们还探讨了清除过程，包括栓子的局部溶栓和外渗或血管吞噬作用。
在正常情况下，栓塞事件与其解决之间存在持续的平衡。例如在心房颤动中发生的微栓塞率增加，或清除减少（可能与内皮细胞功能障碍有关），会扰乱这种平衡。这可能导致毛细血管持续丧失、微梗死和认知能力下降。
