Quantitative Morphology of Cerebral Thrombi Related to Intravital Contraction and Clinical Features of Ischemic Stroke
Quantitative Morphology of Cerebral Thrombi Related to Intravital Contraction and Clinical Features of Ischemic Stroke
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DOI：
10.1161/strokeaha.120.031559
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发表时间：
2020-12-01
期刊：
影响因子：
8.3
通讯作者：
Weisel, John W.
中科院分区：
文献类型：
--
作者：
Khismatullin, Rafael R.;Nagaswami, Chandrasekaran;Weisel, John W.
背景和目的：目的是定量和定性评估脑血栓的组成和结构，并将其与活体凝块收缩（收缩）的体征以及急性缺血性stroke.Methods：我们对41例脑血栓的高分辨率扫描电子显微镜照片进行了定量，以了解其详细的细胞和非细胞组成，并分析了组织学图像的整体结构，重点是红细胞压缩、纤维蛋白年龄和炎症体征。主要细胞类型为核心的多面体压缩红细胞（多角体细胞），纤维蛋白-血小板聚集体集中在外周;这两种结果均表明血栓的活体内收缩。多角体细胞含量与脑卒中严重程度直接相关。纤维蛋白束的流行是更严重的病例的典型特征，而纤维蛋白海绵的含量在病程更有利的病例中占主导地位。脑血栓中的总血小板含量令人惊讶地小，而血小板聚集体的较高含量是中风严重程度的标志。纤维型纤维蛋白在动脉粥样硬化血栓形成中占优势。接受溶栓治疗的患者血栓中老年纤维蛋白占优势，心源性血栓中年轻纤维蛋白占优势。红细胞和纤维蛋白与血小板混合的交替层对于结局更有利的患者的血栓是常见的。血栓与大量的白细胞与致命cases.Conclusions：大多数脑血栓进行体内凝块收缩（收缩），可能被低估的临床重要性。尽管脑血栓的组成和结构具有高度的变异性，但某些类型的血细胞和纤维蛋白结构的含量以及活体收缩的形态学体征与急性缺血性卒中的临床病程和结局相关。
Background and Purpose:The purpose was to assess quantitatively and qualitatively the composition and structure of cerebral thrombi and correlate them with the signs of intravital clot contraction (retraction), as well as with etiology, severity, duration, and outcomes of acute ischemic stroke.Methods:We quantified high-resolution scanning electron micrographs of 41 cerebral thrombi for their detailed cellular and noncellular composition and analyzed histological images for the overall structure with the emphasis on red blood cell compression, fibrin age, and the signs of inflammation.Results:Cerebral thrombi were quite compact and had extremely low porosity. The prevailing cell type was polyhedral compressed erythrocytes (polyhedrocytes) in the core, and fibrin-platelet aggregates were concentrated at the periphery; both findings are indicative of intravital contraction of the thrombi. The content of polyhedrocytes directly correlated with the stroke severity. The prevalence of fibrin bundles was typical for more severe cases, while the content of fibrin sponge prevailed in cases with a more favorable course. The overall platelet content in cerebral thrombi was surprisingly small, while the higher content of platelet aggregates was a marker of stroke severity. Fibrillar types of fibrin prevailed in atherothrombogenic thrombi. Older fibrin prevailed in thrombi from the patients who received thrombolytics, and younger fibrin dominated in cardioembolic thrombi. Alternating layers of erythrocytes and fibrin mixed with platelets were common for thrombi from the patients with more favorable outcomes. Thrombi with a higher number of leukocytes were associated with fatal cases.Conclusions:Most cerebral thrombi undergo intravital clot contraction (retraction) that may be of underestimated clinical importance. Despite the high variability of the composition and structure of cerebral thrombi, the content of certain types of blood cells and fibrin structures combined with the morphological signs of intravital contraction correlate with the clinical course and outcomes of acute ischemic stroke.