急性缺血性卒中血管内治疗血栓标本胆固醇结晶分析

Analysis of cholesterol crystals in thrombi obtained from endovascular treatment of acute ischemic stroke

目的比较急性缺血性卒中不同病因分型患者血栓标本胆固醇结晶比例的差异,并探讨含胆固醇结晶的血栓对血管再通的影响。方法共92例颅内大血管闭塞致急性缺血性卒中患者均行血管内治疗(包括导管抽吸、机械取栓、球囊扩张术和支架植入术),并对取出的血栓标本行病理学检查。结果 92例患者中81例(88.04%)实现血管再通[脑梗死溶栓血流分级(TICI)≥2b级];66例(71.74%)取出血栓;63例(68.48%)行血栓标本病理学检查,包括动脉粥样硬化血栓形成型(AT型)26例(41.27%)、心源性栓塞型24例(38.10%)、其他明确病因型2例(3.17%)以及不明病因型11例(17.46%)。26例AT型患者中单纯血管内治疗18例(69.23%),血管内桥接治疗8例(30.77%);导管抽吸1例(3.85%),机械取栓25例(96.15%),其中单纯机械取栓9例(34.62%)、机械取栓联合球囊扩张术3例(11.54%)、机械取栓联合支架植入术3例(11.54%)、机械取栓联合球囊扩张术和支架植入术10例(38.46%);其中4例(15.38%)血栓标本含胆固醇结晶,含胆固醇结晶与不含胆固醇结晶患者机械取栓次数差异无统计学意义[2.50(2.00,3.00)次对2(2,2)次;Z=-1.155,P=0.248]。AT型与非AT型患者血栓标本胆固醇结晶比例差异有统计学意义[15.38%(4/26)对0/37,Fisher确切概率法:P=0.025],而术后实现血管再通与未实现血管再通患者血栓标本胆固醇结晶比例差异无统计学意义[3.77%(2/53)对2/10,Fisher确切概率法:P=0.115]。结论急性缺血性卒中患者血栓标本含胆固醇结晶的比例较低,但其对AT型的诊断具有特异性,而对术后血管再通无影响。

Objective To compare the difference of the rate of cholesterol crystals in thrombiobtained from patients of acute ischemic stroke with different etiologies and the effect of thrombi containingcholesterol crystals on vascular recanalization. Methods A total of 92 patients with acute ischemic strokecaused by intracranial large vascular occlusion underwent endovascular treatment, such as catheter suction,thrombectomy, balloon dilatation and stent implantation. Histopathological examinations of the retrievedthrombi were performed. Results Of 92 cases, 81 cases（88.04%） achieved recanalization [Thrombolysisin Cerebral Infarction（TICI） ≥ 2 b]. Thrombi were retrieved in 66 cases（71.74%） and 63 cases（68.48%）performed pathological examinations, among whom 26 cases（41.27%） were atherothrombosis（AT）, 24 cases（38.10%） were cardioembolism（CE）, 2（3.17%） were stroke of other determined etiology（SOD） and 11 cases（17.46%） were stroke of undetermined etiology（SUD）. Among 26 AT cases, 18 cases（69.23%） accepted endovascular treatment and 8 cases（30.77%） accepted bridging therapy. One case（3.85%） underwentcatheter suction, and 25 cases（96.15%） underwent thrombectomy, including thrombectomy alone in 9 cases（34.62%）, thrombectomy combined with balloon dilatation in 3 cases（11.54%）, thrombectomy combinedwith stent implantation in 3 cases（11.54%）, thrombectomy combined with balloon dilatation and stentimplantation in 10 cases（38.46%）, respectively. Cholesterol crystals were detected in 4 cases（15.38%）.There was no significant difference in the number of thrombectomy between thrombi with cholesterolcrystals and those without cholesterol crystals [2.50（2.00, 3.00） times vs. 2（2, 2） times; Z =-1.155, P =0.248]. Among 37 non-AT cases, 26 cases（70.27%） accepted endovascular treatment and 11 cases（29.73%） accepted bridging therapy. All of them underwent thrombectomy, including thrombectomy alonein 34 cases（91.89%）, thrombectomy combined with balloon dilatation in one case（2.70%）, thrombectomycombined with stent implantation in 2 cases（5.41%）, respectively. There was statistically significantdifference in the rate of cholesterol crystals between AT cases and non-AT cases [15.38%（4/26） vs. 0/37,Fisher＇s exact probability： P = 0.025]. There was no significant difference in the rate of cholesterol crystalsbetween patients with and without recanalization [3.77%（2/53） vs. 2/10, Fisher＇s exact probability： P =0.115]. Conclusions Although the rate of cholesterol crystals in thrombi of acute ischemic stroke patientsis relatively low, it is specific for diagnosing AT. Besides, cholesterol crystals has no relationship withvascular recanalization.