急性缺血性脑卒中血栓取出物病理成分与临床特征的相关性分析
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南京医科大学科技发展基金重点项目(2017NJMUZD032);江苏省大学生创新创业训练计划重点项目(201910312001Z)


Relationship between thrombi composition and prognosis in patients with acute ischemic stroke undergoing mechanical thrombectomy
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    摘要:

    目的:分析急性缺血性脑卒中机械取栓患者血栓取出物的病理成分,并探讨其与实验室检查、手术操作、预后等临床特征的关系。方法:2018年8月—2019年12月连续入组南京医科大学第二附属医院脑卒中登记系统的70例接受机械取栓的急性缺血性脑卒中患者。采用苏木精-伊红(hematoxylin-eosin,HE)染色方法半定量分析血栓取出物的红细胞、白细胞、纤维蛋白、血小板成分。根据红细胞及纤维蛋白(含血小板)的含量将患者分为红细胞富集组(红细胞含量≥50%)和纤维蛋白富集组(红细胞含量 < 50%)。比较两组之间实验室检查、手术操作、预后等差异。结果:70例急性缺血性脑卒中患者中,49例取得了血栓组织,血栓部位包括颈内动脉、大脑中动脉、基底动脉。红细胞富集组30例,纤维蛋白富集组19例。两组间性别、年龄、高血压、糖尿病、房颤病史、是否静脉溶栓、入院到静脉溶栓时间、入院到穿刺时间、取栓术后改良脑梗死溶栓(modified thrombolysis in cerebral infarction,mTICI)分级、90 d良好预后率差异无统计学意义。急性卒中Org10172治疗试验(the trial of Org 10172 in acute stroke treatment,TOAST)分型显示两组间心源性栓塞的比例差异无统计学意义。纤维蛋白富集组的穿刺到复流的时间[(68.42±29.99)min vs. (87.07±37.29)min,P=0.04]、取栓次数(1.63次vs. 2.20次,P=0.04)低于红细胞富集组,差异有统计学意义。纤维蛋白富集组首次使用抽吸联合支架取栓技术的比例高于红细胞富集组(84.21% vs. 56.67%,P=0.03),差异有统计学意义。结论:血栓成分可能影响取栓策略,纤维蛋白富集血栓与首次使用支架联合中间导管取栓有关,并且与穿刺到复流时间、操作次数减少相关。

    Abstract:

    Objective:The aim of this study was to evaluate thrombi composition and its association with clinical,laboratory,and neurointerventional findings in patients with acute ischemic stoke(AIS) treated by mechanical thrombectomy(MT). Methods:Seventy patients were treated by mechanical thrombectomy using a stent retriever and/or aspiration catheter between August 2018 and December 2019 at the Second Affiliated Hospital of Nanjing Medical University. The retrieved thrombi were quantitatively analyzed to quantify red blood cells,white blood cells,and fibrin by area. We divided the patients into two groups,the fibrin-rich group and the erythrocyte-rich group which were based on the predominant composition in the thrombi. The groups were compared for clinical,and neuro-interventional data. Results:The retrieved thrombi from 49 patients with acute stroke from internal carotid artery,middle cerebral artery,or basilar artery occlusion were histologically analyzed by hematoxylin-eosin(HE). Erythrocyte-rich thrombi were present in 30 cases,while fibrin-rich thrombi were present in 19 cases. A cardioembolic etiology was not significantly more prevalent among the patients with fibrin-rich thrombi than among those with erythrocyte-rich thrombi. All other clinical and laboratory characteristics remained the same. Patients with fibrin-rich thrombi had a shorter time interval between arrival and recanalization [(68.42±29.99)min vs. (87.07±37.29)min,P=0.04)],and less procedure times(1.63 vs. 2.20,P=0.04). The proportion of stent retriever combined aspiration as first-line thrombectomy strategy in fibrin-rich thrombi group was higher than in erythrocyte-rich group(84.21% vs. 56.67%,P=0.03). Conclusion:Fibrin-rich thrombi may influence the thrombectomy strategy and be associated with stent retriever combined aspiration thrombectomy strategy,reduced recanalizational time and procedure times.

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吴岩峰,丁桂兵,陈 亮,刘 梅,刘庆萍,吴 晋.急性缺血性脑卒中血栓取出物病理成分与临床特征的相关性分析[J].南京医科大学学报(自然科学版),2022,42(1):47-52

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  • 收稿日期:2020-02-23
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  • 在线发布日期: 2022-01-27
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