Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke.
Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke.
复制标题
DOI：
10.1161/strokeaha.120.032810
复制
发表时间：
2021-03
期刊：
影响因子：
8.3
通讯作者：
Ariëns RAS
中科院分区：
文献类型：
--
作者：
Jolugbo P;Ariëns RAS
从急性缺血性卒中（AIS）患者中取出的血栓具有高度异质性。最近的数据表明，血栓成分可能影响机械血栓切除术、再通操作次数、回收阻力和溶栓潜力。我们的目的是总结描述血栓成分对AIS患者机械血栓切除术和溶栓疗效影响的证据。遵循了乔安娜·布里格斯研究所指导的范围界定审查方法，该方法是对阿克西和奥马利的改编。综合检索MEDLINE、EMBASE、SCOPUS和Web of Science。文章分为四个关键主题：（i）卒中血栓的组成;（ii）血栓组成和机械血栓切除术;（iii）血栓组成和溶栓治疗;（iv）新型成像和血管内方法。我们的检索识别了1987年至2020年6月发表的698篇文章。从所选文献的参考文献列表中提取其他文献。总体而言，纳入了在40种不同期刊上发表的95篇特定主题的文章。报告显示，卒中中的血栓成分高度异质，包含纤维蛋白、血小板、红细胞（RBC）、血管性血友病因子（vWF）和中性粒细胞胞外陷阱。血栓可大致分为富含纤维蛋白和RBC的凝块。与富含RBC的凝块相比，富含纤维蛋白的凝块与再通操作增加、手术时间延长和临床结局较差相关。考虑到凝块异质性的血栓检测或治疗进展可能能够改善未来卒中的血管内和溶栓治疗。
Thrombi retrieved from patients with acute ischaemic stroke (AIS) are highly heterogeneous. Recent data suggest that thrombus composition may impact on mechanical thrombectomy, the number of recanalization manoeuvres, resistance to retrieval, and on thrombolytic potential. Our aim was to summarise evidence describing the impact of thrombus composition on efficacy of mechanical thrombectomy and thrombolysis in patients with AIS. The scoping review methodology guided by the Joanna Briggs Institute, an adaption of the Arksey and O’Malley, was followed. Comprehensive searches were conducted in MEDLINE, EMBASE, SCOPUS and Web of Science. Articles were classified into four key themes: (i) composition of stroke thrombi; (ii) thrombus composition and mechanical thrombectomy; (iii) thrombus composition and thrombolytic therapy; (iv) novel imaging and endovascular approaches. Our search identified 698 articles published from 1987 to June 2020. Additional articles were extracted from reference lists of the selected articles. Overall, 95 topic-specific articles identified for inclusion published in 40 different journals were included. Reports showed that thrombus composition in stroke was highly heterogeneous, containing fibrin, platelets, red blood cells (RBC), von Willebrand Factor (vWF), and neutrophil extracellular traps. Thrombi could roughly be divided in fibrin- and RBC-rich clots. Fibrin-rich clots were associated with increased recanalization manoeuvres, longer procedure time and less favourable clinical outcomes compared RBC-rich clots. Advances in detection or treatment of thrombi that take into account clot heterogeneity may be able to improve future endovascular and thrombolytic treatment of stroke.