Erythrocyte-Rich Thrombus Is Associated with Reduced Number of Maneuvers and Procedure Time in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy
Erythrocyte-Rich Thrombus Is Associated with Reduced Number of Maneuvers and Procedure Time in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy
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DOI：
10.1159/000486042
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发表时间：
2018-01-01
影响因子：
1.9
通讯作者：
Miya, Fumitaka
中科院分区：
文献类型：
--
作者：
Maekawa, Kota;Shibata, Masunari;Miya, Fumitaka
背景：只有少数研究调查了回收血栓的组织病理学与临床结局之间的关系。本研究旨在评价因急性大血管闭塞而接受机械血栓切除术治疗的患者的血栓组成及其与临床、实验室和神经介入结果的相关性。研究方法：2015年8月至2016年8月期间，在我们的机构，79例患者使用支架取栓器和/或抽吸导管接受了机械血栓切除术治疗。对回收的血栓进行定量分析，以按面积量化红细胞、白色细胞和纤维蛋白。我们根据血栓中的主要成分将患者分为两组-富纤维蛋白组和富红细胞组。比较各组的影像学、临床和神经介入数据。结果如下：对43例颈内动脉、大脑中动脉或基底动脉闭塞的急性脑卒中患者取出的血栓进行组织学分析。富红细胞血栓18例，富纤维蛋白血栓25例。富含纤维蛋白血栓患者的心源性栓塞病因明显高于富含红细胞血栓患者。CT图像显示，富红细胞血栓患者的血栓密度衰减大于富纤维蛋白血栓患者。所有其他临床和实验室特征保持不变。富红细胞血栓患者的再通操作次数较少，手术时间较短，到达和再通之间的时间间隔较短，最终再通手术中支架取栓器的百分比较高。闭塞血管无显著差异。结论：在这项研究中，富含红细胞的血栓与非心源性栓塞病因、较高的血栓密度和缩短的手术时间相关。(C)2018作者（S）由S发布。Karger AG，巴塞尔
Background: Only few studies have investigated the relationship between the histopathology of retrieved thrombi and clinical outcomes. This study aimed to evaluate thrombus composition and its association with clinical, laboratory, and neurointerventional findings in patients treated by mechanical thrombectomy due to acute large vessel occlusion. Methods: At our institution, 79 patients were treated by mechanical thrombectomy using a stent retriever and/or aspiration catheter between August 2015 and August 2016. The retrieved thrombi were quantitatively analyzed to quantify red blood cells, white blood cells, and fibrin by area. We divided the patients into two groups - a fibrin-rich group and an erythrocyte-rich group based on the predominant composition in the thrombus. The groups were compared for imaging, clinical, and neurointerventional data. Results: The retrieved thrombi from 43 patients with acute stroke from internal carotid artery, middle cerebral artery, or basilar artery occlusion were histologically analyzed. Erythrocyte-rich thrombi were present in 18 cases, while fibrin-rich thrombi were present in 25 cases. A cardioembolic etiology was significantly more prevalent among the patients with fibrin-rich thrombi than among those with erythrocyte-rich thrombi. Attenuation of thrombus density as shown on computed tomography images was greater in patients with erythrocyte-rich thrombi than in those with fibrin-rich thrombi. All other clinical and laboratory characteristics remained the same. Patients with erythrocyte-rich thrombi had a smaller number of recanalization maneuvers, shorter procedure times, a shorter time interval between arrival and recanalization, and a higher percentage of stent retrievers in the final recanalization procedure. The occluded vessels did not differ significantly. Conclusions: In this study, erythrocyte-rich thrombus was associated with noncardioembolic etiology, higher thrombus density, and reduced procedure time. (C) 2018 The Author(s) Published by S. Karger AG, Basel