Didisheim P, Fuster V
Clin Neurosurg. 1976;23:125-39. doi: 10.1093/neurosurgery/23.cn_suppl_1.125.
This review has highlighted some of the factors which influence the formation and fate of thrombi. Rheology and flow, the coagulation mechanism, the fibrinolytic enzyme system, and the properties of platelets to adhere and aggregate all play a significant role. Of paramount importance to neurosurgeons is the role of the vascular wall in thrombogenesis. The ulcerated atherosclerotic plaque demonstrates this point. Factors contributing to thromboembolism in this setting include stenosis and reduced flow, turbulence, and the elements in the lesion with which blood interacts. These are principally collagen, ADP, fatty acids, and the thromboplastic activity of vascular subendothelial tissue. Current concepts of the etiologies of atherosclerosis were discussed. Along with other predisposing factors, platelets may play a significant role in the initiation of the process. The current status of clinical trials with inhibitors of platelet function in the treatment of cerebrovascular disorders was reviewed. In vascular reconstructive surgery, the principles which underlie good technique are those which best insure against thrombosis. The briefest possible period of stasis during surgery should be maintained. The reconstruction should result in a smooth blood flow pattern with rapid runoff and minimal stenosis or gaps between apposed endothelial surfaces.
本综述着重介绍了一些影响血栓形成及转归的因素。流变学与血流、凝血机制、纤维蛋白溶解酶系统以及血小板黏附与聚集的特性均发挥着重要作用。对神经外科医生而言至关重要的是血管壁在血栓形成过程中的作用。溃疡性动脉粥样硬化斑块就说明了这一点。在此情况下促成血栓栓塞的因素包括狭窄和血流减少、湍流以及血液与之相互作用的病变部位的成分。这些成分主要是胶原蛋白、二磷酸腺苷、脂肪酸以及血管内皮下组织的促凝血活性。文中讨论了动脉粥样硬化病因的当前概念。除其他诱发因素外，血小板可能在该过程的起始阶段发挥重要作用。综述了血小板功能抑制剂治疗脑血管疾病的临床试验现状。在血管重建手术中，良好技术所依据的原则是最能确保预防血栓形成的原则。手术期间应保持尽可能短的血流停滞时间。重建应形成平滑的血流模式，具有快速的血流流出，且相对的内皮表面之间的狭窄或间隙最小。
