Analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke
Analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke
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DOI：
10.1161/01.str.0000230307.03438.94
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发表时间：
2006-08-01
期刊：
影响因子：
8.3
通讯作者：
Saver, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Marder, Victor J.;Chute, Dennis J.;Saver, Jeffrey L.
背景和目的--关于导致急性卒中的血栓栓塞的组织学结构的信息提供了对发病机制和临床管理的深入了解。方法--本报告描述了对25例急性缺血性卒中患者的大脑中动脉（MCA）和颅内颈动脉（伊卡）进行血管内机械提取的血栓栓塞的组织学分析。的血栓栓塞共享随机纤维蛋白的结构特征：血小板沉积物散布有线性集合的有核细胞（单核细胞和中性粒细胞）和局限的富红细胞区域。这种组织学常见于心源性栓塞和动脉粥样硬化性栓塞。仅由红细胞组成的“红色”凝块不常见，仅在不完全提取时观察到，胆固醇晶体明显不存在。无法从29例并发患者中检索到的血栓栓塞的组织学可能不同。没有> 3 mm宽的血栓引起仅限于MCA的卒中，也没有> 5 mm宽的血栓从伊卡中取出。一个mycoplasty栓子被成功地删除在1例中，和一个小的粥样硬化和附着内膜被删除，而没有临床后果从another. Conclusions血栓栓塞检索从MCA或颅内伊卡的急性缺血性中风患者有相似的组织学成分，无论是来自心脏或动脉源。栓子的大小决定了最终的目的地，那些> 5 mm宽的栓子可能完全绕过脑血管。纤维蛋白：血小板模式占主导地位的血栓栓塞结构提供了一个基础，抗血小板和抗凝治疗策略在中风预防。
Background and Purpose-Information regarding the histological structure of thromboemboli that cause acute stroke provides insight into pathogenesis and clinical management.Methods-This report describes the histological analysis of thromboemboli retrieved by endovascular mechanical extraction from the middle cerebral artery (MCA) and intracranial carotid artery (ICA) of 25 patients with acute ischemic stroke.Results-The large majority (75%) of thromboemboli shared architectural features of random fibrin:platelet deposits interspersed with linear collections of nucleated cells (monocytes and neutrophils) and confined erythrocyte-rich regions. This histology was prevalent with both cardioembolic and atherosclerotic sources of embolism. "Red" clots composed uniquely of erythrocytes were uncommon and observed only with incomplete extractions, and cholesterol crystals were notably absent. The histology of thromboemboli that could not be retrieved from 29 concurrent patients may be different. No thrombus > 3 mm wide caused stroke limited to the MCA, and no thrombus > 5 mm wide was removed from the ICA. A mycotic embolus was successfully removed in 1 case, and a small atheroma and attached intima were removed without clinical consequence from another.Conclusions-Thromboemboli retrieved from the MCA or intracranial ICA of patients with acute ischemic stroke have similar histological components, whether derived from cardiac or arterial sources. Embolus size determines ultimate destination, those > 5 mm wide likely bypassing the cerebral vessels entirely. The fibrin:platelet pattern that dominates thromboembolic structure provides a foundation for both antiplatelet and anticoagulant treatment strategies in stroke prevention.