Risk of Thrombus Fragmentation during Endovascular Stroke Treatment
Risk of Thrombus Fragmentation during Endovascular Stroke Treatment
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DOI：
10.3174/ajnr.a5105
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发表时间：
2017-05-01
影响因子：
3.5
通讯作者：
Huber, T.
中科院分区：
文献类型：
--
作者：
Kaesmacher, J.;Boeckh-Behrens, T.;Huber, T.
背景和目的：围手术期血栓粉碎是血管内卒中治疗的相关风险。由于影响其发生的因素在很大程度上是未知的，本研究解决了血栓组织学和凝块stability.MATERIALS和METHODS之间的潜在关系：85例前循环中风与血栓切除术治疗的患者被纳入本回顾性研究。评价了取出原发血栓后的栓子数量和位置、操作次数和TICI评分。H&E和中性粒细胞弹性蛋白酶染色回收的凝块进行，和血栓成分的半定量测量与程序parameter.Results相关：血栓回收所需的操作和远端和中间栓塞的数量之间呈负相关（斯皮尔曼r，-0.23; P = 0.032）。年轻患者的围手术期血栓碎裂风险较高（斯皮尔曼r，-0.23; P = .032）。桥接溶栓往往与较少的操作（2 vs 3，P = 0.054），但更多的栓塞（1 vs 0，P = 0.067）。虽然没有发现手术参数与红/白色血细胞和纤维蛋白/血小板分数之间的一致相关性，但血栓内较高数量的中性粒细胞弹性蛋白酶阳性细胞与多发性栓塞的发生独立相关。（调整后的OR，4.6; 95% CI，1.1 -19.7; P = 0.041）和完全再通率较低结论：年龄较小、血栓易于取出和桥接溶栓可能是围手术期血栓碎裂的危险因素。标准组织学染色的结果未提供血栓切除术相关血栓稳定性的见解。然而，血栓组织中较高的中性粒细胞水平与围手术期血栓碎裂风险增加相关。这一观察结果与中性粒细胞弹性蛋白酶的溶栓能力一致，并指出其在卒中血栓切除术中的潜在临床相关性。
BACKGROUND AND PURPOSE: Periprocedural thrombus fragmentation is a relevant risk in endovascular stroke treatment. Because factors influencing its occurrence are largely unknown, this study addresses a potential relationship between thrombus histology and clot stability.MATERIALS AND METHODS: Eighty-five patients with anterior circulation stroke treated with thrombectomy were included in this retrospective study. The number and location of emboli after retrieving the primary thrombus, the number of maneuvers, and TICI scores were evaluated. H&E and neutrophil elastase staining of retrieved clots was performed, and semiquantitative measurements of thrombus components were correlated with procedural parameters.RESULTS: An inverse correlation between maneuvers required for thrombus retrieval and the number of distal and intermediate emboli was observed (Spearman r, -0.23; P = .032). Younger patients were at higher risk for periprocedural thrombus fragmentation (Spearman r, -0.23; P = .032). Bridging thrombolysis tended to be associated with fewer maneuvers (2 vs 3, P =.054) but more emboli (1 vs 0, P =.067). While no consistent correlation between procedural parameters and red/white blood cells and fibrin-/platelet fractions could be found, higher amounts of neutrophil elastase positive cells within the thrombus were independently associated with the occurrence of multiple emboli (adjusted OR, 4.6; 95% CI,1.1-19.7; P = .041) and lower rates of complete recanalization (adjusted OR, 0.3; 95% CI, 0.1-0.9; P =.050).CONCLUSIONS: Younger age, easy-to-retrieve thrombi, and bridging thrombolysis may be risk factors for periprocedural thrombus fragmentation. Findings from standard histologic stains did not provide insight into thrombectomy-relevant thrombus stability. However, higher neutrophil levels in the thrombus tissue were related to an increased risk of periprocedural thrombus fragmentation. This observation aligns with the proposed thrombolytic capacity of neutrophil elastase and points to its potential clinical relevance in the context of stroke thrombectomy.