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

doi:10.16016/j.1000-5404.201907207

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

更新时间：2021-08-02

- Correlation of thrombus composition with prognosis of patients with acute cerebral infarction
- Journal of Army Medical University Vol. 41, Issue 20, Pages: 1976-1981(2019)
- 作者机构：
  
  陆军军医大学(第三军医大学)第一附属医院神经内科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201907207
  CLC： R743.3
- Published：2019，
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[1]王素匣,吴虹辰,文岚,李光建,陈林,刘渠,吴敏,刘璐,陈康宁,周振华.急性脑梗死取栓患者血栓成分与预后的特性分析[J].第三军医大学学报,2019,41(20):1976-1981.

Correlation of thrombus composition with prognosis of patients with acute cerebral infarction. [J]. Journal of Army Medical University 41(20):1976-1981(2019)
[1]王素匣,吴虹辰,文岚,李光建,陈林,刘渠,吴敏,刘璐,陈康宁,周振华.急性脑梗死取栓患者血栓成分与预后的特性分析[J].第三军医大学学报,2019,41(20):1976-1981. DOI： 10.16016/j.1000-5404.201907207.

Correlation of thrombus composition with prognosis of patients with acute cerebral infarction. [J]. Journal of Army Medical University 41(20):1976-1981(2019) DOI： 10.16016/j.1000-5404.201907207.

摘要

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。

Abstract

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.

关键词

急性脑梗死机械取栓术血栓成分预后

Keywords

acute cerebral infarctionmechanical recanalizationthrombotic componentsprognosis

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