Age and composition of the thrombus retrieved by mechanical thrombectomy from patients with acute ischemic stroke are associated with revascularization and clinical outcomes
Age and composition of the thrombus retrieved by mechanical thrombectomy from patients with acute ischemic stroke are associated with revascularization and clinical outcomes
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DOI：
10.1016/j.thromres.2022.09.004
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发表时间：
2022-09-18
影响因子：
7.5
通讯作者：
Matsumoto, Masanori
中科院分区：
文献类型：
--
作者：
Shimizu, Hisao;Hatakeyama, Kinta;Matsumoto, Masanori
简介：了解机械取栓术取出的中风血栓的成分对于阐明中风的发病机制至关重要。然而，准确、客观地评估血栓成分是很困难的。免疫组织化学染色用于评估血栓成分和年龄。材料和方法：对从因急性大血管缺血性卒中接受机械血栓切除术的患者中取出的连续血栓（n = 108）进行回顾性分析。粒细胞和 CD163 的溶解特征被估计为心源性栓塞 (CE) 血栓年龄的指标。结果：脑卒中亚型如下：CE，74例；大动脉粥样硬化，11；病因未定，12；和其他确定的病因，11. 根据中风亚型，血栓成分没有统计学差异。纤维蛋白面积与红细胞（RBC）和血小板面积呈正相关。以下分析仅使用 CE 进行。关于年龄，根据溶解特征，30.0% 的血栓被判定为新鲜，70.0% 的血栓被判定为较旧。陈旧血栓的红细胞面积小于新鲜血栓。陈旧血栓的穿刺至再灌注时间比新鲜血栓长。与缺乏血小板的血栓相比，富含血小板的血栓与更多的操作、更少的 TICI 3 发生率以及不利的功能结果相关。使用抗凝剂的血栓中CD163阳性细胞的数量高于未使用抗凝剂的血栓。结论：血栓成分与血运重建和临床结果相关。急性缺血性血栓的成分可能反映中风的病理生理学并影响治疗效果。
Introduction: Understanding the composition of stroke thrombi retrieved by mechanical thrombectomy is essential to clarify the pathogenesis of stroke. However, it is difficult to evaluate thrombus composition precisely and objectively. Immunohistochemical staining was used to evaluate thrombus composition and age. Materials and methods: Consecutive thrombi (n = 108) retrieved from patients who underwent mechanical thrombectomy for acute large-vessel ischemic stroke were retrospectively analyzed. Lytic features of granulocytes and CD163 were estimated as indicators of the age of the cardioembolic (CE) thrombus. Results: The stroke subtypes were as follows: CE, 74 cases; large artery atherosclerosis, 11; undetermined etiology, 12; and other determined etiology, 11. There were no statistical differences in thrombi composition ac-cording to stroke subtypes. The fibrin area was positively correlated with the red blood cell (RBC) and platelet areas. The following analysis was performed using CE only. Regarding age, the thrombus was judged as fresh in 30.0 % and older in 70.0 % based on the lytic features. The RBC areas of older thrombi were smaller than those of fresh thrombi. The puncture-to-reperfusion time of older thrombi was longer than that of fresh thrombi. Platelet -rich thrombi were associated with a greater number of maneuvers, a smaller prevalence of TICI 3, and unfavorable functional outcomes compared to platelet-poor thrombi. The number of CD163 positive cells in thrombi with anticoagulants was higher than in those without anticoagulants. Conclusion: Thrombus composition correlated with revascularization and clinical outcomes. The composition of an acute ischemic thrombus may reflect the pathophysiology of stroke and influence treatment efficacy.