急性脑梗死取栓患者血栓成分与预后的特性分析

Correlation of thrombus composition with prognosis of patients with acute cerebral infarction

目的分析急性脑梗死血管内支架取栓的患者血栓成分与其预后特性。方法回顾性分析2015年6月至2019年2月在我科诊断为急性脑梗死,经卒中绿色通道小组评定可行血管内机械取栓治疗且成功取出血栓的48例患者的临床资料,评价其TOAST分型、血栓位置、取栓次数、手术再通时间、TICI分级和是否使用rt-PA静脉溶栓等,进行3个月时mRS评分随访。同时对所取的血栓进行HE染色分析血栓成分,最终分析血栓成分与预后的可能相关性。结果根据TOAST分型48例患者中心源性卒中患者24例,大动脉粥样硬化性卒中患者16例,不明原因卒中患者8例。其中心源性血栓中纤维蛋白/血小板的含量比例明显高于大动脉粥样硬化性血栓[(62.9±15.9)%vs(50.9±14.1)%,P<0.05],差异有统计学意义。心源性血栓中的红细胞比例明显低于大动脉粥样硬化性血栓[(32.0±15.3)%vs(43.6±15.1)%,P<0.05],差异有统计学意义。根据血栓组成成分的比例,血栓中富含纤维蛋白/血小板的患者35例,血栓中富含红细胞的患者13例。在3个月mRS评分预后良好率中,血栓中富含纤维蛋白/血小板的患者明显低于富含红细胞血栓的患者(26%vs 62%,P<0.05),差异有统计学意义。本组取栓患者中使用rt-PA静脉溶栓患者的手术再通时间明显短于未使用rt-PA静脉溶栓患者[(90±47.6)min vs(131.6±57.5)min,P<0.05],差异有统计学意义。结论急性脑梗死取栓患者血栓成分中纤维蛋白/血小板含量较高的患者预后较差;使用rt-PA静脉溶栓的患者手术再通时间较短。

Objective To analyze the correlation between thrombus composition and the prognosis of patients with acute cerebral infarction after mechanical thrombectomy. Methods This retrospective analysis was conducted among 48 patients with the diagnosis of acute ischemic stroke, who were eligible for mechanical thrombectomy as assessed by the first aid group and successfully underwent the surgery between June, 2015 and February, 2019. The clinical data were collected from the patients including TOAST(trail of org 10172 in acute stroke treatment) classification, thrombus position, number of stents placed, recanalization time, thrombolysis in cerebral infarction(TICI) grading and the use of recombinant tissue plasminogen activator(rt-PA) for intravenous thrombolysis. The patients were followed up and the modified Rankin scale(mRS) score at 3 months after the surgery was recorded. The composition of the retrieved thrombus was examined using HE staining, and the correlation between thrombus composition and the patients’ outcomes was analyzed. Results Of the 48 patients included, 24 were diagnosed to have cardioembolic stroke, 16 had large artery atherosclerotic stroke, and 8 had stroke with unknown etiology. A significant difference was found in fibrin and platelet contents between the cardiogenic thrombi and atherosclerotic thrombi [(62.9±15.9)% vs(50.9±14.1)%, P<0.05]. Fibrin-rich thrombi were found in 35 patients, and erythrocyte-rich thrombi were found in 13 patients;the percentage of favorable mRS scores at the end of the third month after the surgery was significantly lower in the former patients than in the latter patients(26% vs 62%, P<0.05). During mechanical thrombectomy, the recanalization time was significantly shorter in patients receiving intravenous thrombolysis with rt-PA than in those without the use of rt-PA(90±47.6 vs 131.6 ± 57.5 min, P<0.05). Conclusion In patients with acute ischemic stroke undergoing mechanical thrombectomy, high fibrin and platelet contents in the thrombus are associated with a poor prognosis, and intravenous thrombolysis with rt-PA is associated with a shortened recanalization time during mechanical thrombectomy.