背景:机械血栓切除术已成为急性缺血性卒中的主要血管内治疗方法。许多研究已经调查了血栓组成与因素之间的关系,例如药物溶栓,卒中病因,机械血栓切除术,和放射成像。然而,有限的研究探讨了血栓成分与临床结局之间的关联.
方法:这项回顾性分析检查了2020年5月至2023年5月期间50例急性缺血性卒中患者的血栓的组织病理学检查。使用HE染色定量红细胞的比例来评估取回的血栓的组成。白细胞,血小板,和纤维蛋白.根据血栓的主要成分,患者分为富含红细胞和富含纤维蛋白的两组.人口统计,临床特征,回顾性收集美国国立卫生研究院卒中量表(NIHSS)评分和改良Rankin量表(mRS)评分评估的临床结局.
结果:在50名患者中,23人被归类为红细胞丰富组,和27被归类为富含纤维蛋白组。两组在年龄方面无显著差异,性别,中风亚型,高血压和糖尿病史,血栓位置,NIHSS得分,MRS入学成绩,从症状发作到住院和再灌注的时间间隔,或再灌注成功率。然而,富含红细胞的血栓与从穿刺到再灌注的较短时间间隔有关。大动脉粥样硬化和心脏栓塞之间的红细胞分数和纤维蛋白/血小板分数没有发现显着差异。在90天的随访中,与富含纤维蛋白的血栓患者相比,富含红细胞的血栓患者的NIHSS评分更低,功能结局更有利(mRS评分为0~2).
结论:富含红细胞的血栓与急性缺血性卒中患者从穿刺到再灌注的较短的时间间隔和良好的临床结局有关。血栓的组成可能会影响血管内治疗的血栓切除策略。
BACKGROUND: Mechanical thrombectomy has emerged as the primary endovascular treatment for acute ischemic stroke. Numerous studies have investigated the relationship between thrombus composition and factors such as pharmacological thrombolysis, stroke etiology, mechanical thrombectomy, and radiological imaging. However, limited research has explored the association between thrombus composition and clinical outcomes.
METHODS: This retrospective analysis examined the histopathological examination of thrombi retrieved from 50 patients with acute ischemic stroke between May 2020 and May 2023. The composition of the retrieved thrombi was assessed using HE staining to quantify the proportions of red blood cells, white blood cells, platelets, and fibrin. Based on the predominant composition of the thrombus, the patients were divided into two groups: erythrocyte-rich and fibrin-rich. Demographics, clinical characteristics, and clinical outcomes assessed by the National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) scores were collected retrospectively.
RESULTS: Of the 50 patients, 23 were classified in the erythrocyte-rich group, and 27 were classified in the fibrin-rich group. There were no significant differences between the two groups in terms of age, sex, stroke subtype, history of hypertension and diabetes, thrombus location, NIHSS scores, mRS scores on admission, the time interval from symptom onset to hospitalization and reperfusion, or the rate of successful reperfusion. However, erythrocyte-rich thrombi were associated with a shorter time interval from puncture to reperfusion. No significant differences were found in the red blood cell fraction and fibrin/platelet fraction between large artery atherosclerosis and cardioembolism. At the 90-day follow-up, patients with erythrocyte-rich thrombi exhibited lower NIHSS scores and more favorable functional outcomes (mRS scores of 0-2) compared to those with fibrin-rich thrombi.
CONCLUSIONS: Erythrocyte-rich thrombi were linked to shorter time intervals from puncture to reperfusion and favorable clinical outcomes in patients with acute ischemic stroke. The composition of the thrombus may influence the thrombectomy strategy for endovascular therapy.