Mechanical behavior of in vitro blood clots and the implications for acute ischemic stroke treatment
Mechanical behavior of in vitro blood clots and the implications for acute ischemic stroke treatment
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DOI：
10.1136/neurintsurg-2019-015489
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发表时间：
2020-09-01
影响因子：
4.8
通讯作者：
Gilvarry, Michael
中科院分区：
文献类型：
--
作者：
Johnson, Sarah;Chueh, Juyu;Gilvarry, Michael
背景血凝块的机械性能受血凝块内组分的组成和排列的影响。这项工作研究了血小板驱动的收缩对血凝块微观结构和机械行为的影响，并提供了一些机械血栓切除术的启示。方法从不同红细胞压积（%H）的血液混合物中制备血小板收缩凝块类似物（PCC）和非收缩凝块类似物（NCC）。进行机械测试以比较类似物与先前测试的人血栓栓塞的行为。扫描电子显微镜和组织学研究了凝块的微观结构和组成。还研究了凝块性质与其在机械行为期间的行为之间的关联。结果总体而言，在所有血细胞比容中，发现PCC比NCC更硬。具有低%H的PCC通过单独接触抽吸或使用支架取栓器完全回收抵抗完全摄入。具有较高%H的PCC和所有NCC均完全可回收，尽管在具有较高%H的凝块中碎片化的可能性增加。在组织学上，具有相同%H的PCC和NCC之间的RBC和纤维蛋白含量几乎没有差异。然而，两组的微观结构差异显著。结论：本研究成功制备了一系列具有一定力学性能的血栓类似物，可用于急性缺血性脑卒中的体外模型。血小板收缩显著影响凝块体积和微观结构，进而影响凝块硬度。机械性能和微观结构的显著差异，但组织学上没有明显差异，这意味着单独对血栓形成的人体血栓进行组织学研究可能无法预测血栓切除术中血栓的机械行为。
Background Clot mechanical properties are influenced by composition and the arrangement of components within the clot. This work investigates the effects of platelet-driven contraction on blood clot microstructure and mechanical behavior, and provides insight into some implications for mechanical thrombectomy. Methods Platelet-contracted clot analogues (PCCs) and non-contracted clot analogues (NCCs) were prepared from blood mixtures of various hematocrits (%H), that is, the volume percentage of red blood cells (RBCs) in the mixture. Mechanical testing was performed to compare the behavior of the analogues with previously tested human thromboemboli. Scanning electron microscopy and histology investigated the clot microstructure and composition. The association between clot properties and their behavior during mechanical behavior was also investigated. Results Overall, PCCs were found to be stiffer than NCCs, across all hematocrits. PCCs with a low %H resisted complete ingestion via contact aspiration alone or complete retrieval with stent-retrievers. PCCs with a higher %H and all NCCs were fully retrievable, although the likelihood of fragmentation was increased in clots with a greater %H. Histologically, there was little difference in the RBC and fibrin content between PCCs and NCCs with the same %H. However, the microstructure of the two groups differed significantly. Conclusion A selection of repeatable clot analogues with a range of mechanical properties have been developed for in vitro modeling of acute ischemic stroke. Platelet contraction significantly affects clot volume and microstructure, and in turn clot stiffness. The significant difference in mechanical properties and microstructure, but without an appreciable difference in histology, implies that histological studies of explanted human clots alone may not prove to be predictive of the mechanical behavior of the clots in thrombectomy.