Ogata J, Masuda J, Yutani C, Yamaguchi T
Research Institute, National Cardiovascular Center, Osaka, Japan.
J Neurol Neurosurg Psychiatry. 1994 Jan;57(1):17-21. doi: 10.1136/jnnp.57.1.17.
The mechanisms of thrombus formation in atherosclerotic cerebral arteries are still controversial, although intraplaque haemorrhage and rupture of the atheromatous plaques have been proposed. A histopathological analysis of segments of the thrombosed large intracranial arteries was carried out on eight patients who died within 28 days after brain infarction. The study revealed occlusive thrombi in six and mural thrombi in two, developing mostly at the site of greatest stenosis or just distal to it. The histological characteristics of the thrombosed arteries were plaque rupture in three, intramural haemorrhage in one, ulceration in one, and thrombosis in the absence of plaque rupture or intramural haemorrhage in three. Occlusive emboli distal to the site of cerebral artery thrombosis (intracranial artery-to-artery thromboembolism) were observed in two. The following conclusions were drawn from the study: 1) plaque rupture or intraplaque haemorrhage is not a sine qua non for cerebral artery thrombosis; 2) occlusions occur at the site of greatest luminal compromise or just distal to it, and 3) non-occlusive mural thrombosis can occur in the absence of plaque rupture and eventually lead to local occlusion or distal embolisation.
尽管有人提出动脉粥样硬化性脑动脉中血栓形成的机制可能是斑块内出血和动脉粥样硬化斑块破裂，但这些机制仍存在争议。对8例在脑梗死后28天内死亡的患者的颅内大血栓形成动脉段进行了组织病理学分析。研究发现，6例为闭塞性血栓，2例为壁血栓，大多发生在狭窄最严重的部位或其远端。血栓形成动脉的组织学特征为：3例斑块破裂，1例壁内出血，1例溃疡，3例在无斑块破裂或壁内出血的情况下形成血栓。2例在脑动脉血栓形成部位远端观察到闭塞性栓子（颅内动脉至动脉血栓栓塞）。该研究得出以下结论：1）斑块破裂或斑块内出血并非脑动脉血栓形成的必要条件；2）闭塞发生在管腔狭窄最严重的部位或其远端；3）在无斑块破裂的情况下可发生非闭塞性壁血栓形成，并最终导致局部闭塞或远端栓塞。
