Shell Versus Core Architecture and Biology of Thrombi in Acute Ischemic Stroke: A Systematic Review.
Shell Versus Core Architecture and Biology of Thrombi in Acute Ischemic Stroke: A Systematic Review.
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DOI：
10.1177/10760296231213632
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发表时间：
2023-01
影响因子：
2.9
通讯作者：
Kadirvel, Ram
中科院分区：
文献类型：
--
作者：
Mereuta, Oana Madalina;Agarwal, Tamanna;Ghozy, Sherief;Dai, Daying;Arul, Santhosh;Brinjikji, Waleed;Kallmes, David F.;Kadirvel, Ram
外壳的存在最近被描述为急性缺血性卒中（AIS）血栓的常见特征。我们对目前有关髋臼杯发生、结构和临床意义的文献进行了系统综述。根据PRISMA指南，我们检索了奥维德科克伦对照试验中心注册中心、Embase、Medline、Scopus和Web of Science，以寻找报告AIS血栓和凝块类似物组成和结构的研究。将识别的研究添加到Covidence软件中进行初步筛选。两名评审员独立筛选标题和摘要，然后进行全文筛选。从1290项识别的研究中，10项纳入本综述。使用组织学/免疫组织化学/免疫荧光的研究将纤维蛋白、血小板、血管性血友病因子和中性粒细胞胞外陷阱描述为壳的主要成分。扫描电子显微镜显示了致密、紧凑的纤维蛋白/血小板丰富的外壳，以及富含多角体细胞的核心。微流体研究确定了高度活化的P-选择素阳性血小板和纤维蛋白形成核心，而二级激动剂二磷酸腺苷和血栓烷，沿着松散包装的P-选择素阴性血小板构成外壳。壳体的组成、压实和完整性可能影响溶栓和血运重建结局。绝大多数研究都支持这一结论。
The presence of an outer shell has been recently described as a common feature of acute ischemic stroke (AIS) thrombi. We performed a systematic review of the current literature on shell genesis, structure, and clinical significance. Following PRISMA guidelines, we searched Ovid Cochrane Central Register of Controlled Trials, Embase, Medline, Scopus, and Web of Science for studies reporting the composition and structure of AIS thrombi and clot analogs. Identified studies were added to Covidence software for primary screening. Two reviewers independently screened titles and abstracts followed by full-text screening. From 1290 identified studies, 10 were included in this review. Studies using histology/immunohistochemistry/immunofluorescence described fibrin, platelets, von Willebrand factor, and neutrophil extracellular traps as the main components of the shell. Scanning electron microscopy demonstrated a dense, compact fibrin/platelet-rich shell, and a core rich in polyhedrocytes. Microfluidics studies identified highly activated P-selectin-positive platelets and fibrin forming the core while secondary agonists adenosine diphosphate and thromboxane, along with loosely packed P-selectin-negative platelets constituted the shell. The composition, compaction, and integrity of the shell may impact thrombolysis and revascularization outcomes. The preponderance of studies supported this conclusion.
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