急性缺血性脑卒中栓子成分与手术过程及临床结局关系的探讨  

Thrombus formation associated with operation procedure and clinical outcome in patients with acute ischemic stroke undergoing mechanical thrombectomy

作　　者：倪小宇[1] 吴嶛 赵卫东[1] 吴健[2] 黄伟[3] 徐长松[1] 左鹏 倪贵华[1] Ni Xiaoyu;Wu Liao;Zhao Weidong;Wu Jian;Huang Wei;Xu Changsong;Zuo Peng;Ni Guihua(Department of Neurology,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian,Jiangsu 223300,China;Department of Pathology,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian,Jiangsu 223300,China;Department of Radiology,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院神经内科,江苏淮安223300 [2]南京医科大学附属淮安第一医院病理科,江苏淮安223300 [3]南京医科大学附属淮安第一医院影像科,江苏淮安223300

出　　处：《中华神经科杂志》2021年第7期670-676,共7页Chinese Journal of Neurology

摘　　要：目的研究缺血性脑卒中的栓子成分与血管开通程度、手术过程及临床预后之间的关系。方法连续纳入2018年1月至2020年1月在南京医科大学附属淮安第一医院进行支架取栓和(或)吸栓的大血管闭塞性脑梗死患者192例,获得的栓子成分主要是红细胞、纤维蛋白、白细胞和血小板,按照栓子的主要成分将患者分成红细胞为主组和纤维蛋白为主组,比较两组患者的一般临床特征、血管闭塞处的CT值、手术时间、取栓次数、血管再通程度和临床预后等数据之间的差异。结果有138例大血管闭塞脑梗死患者取出了血栓并进行了病理检查,患者血管闭塞的部位包括颈内动脉56例、大脑中动脉62例、椎动脉颅内段和基底动脉各20例。59例患者血栓成分以红细胞为主,79例患者以纤维蛋白为主。心源性脑栓塞患者血栓成分以纤维蛋白为主[77.2%(61/79)],非心源性脑栓塞患者血栓成分以红细胞为主[45.8%(27/59),χ^(2)=8.115,P=0.004]。以红细胞为主的患者较以纤维蛋白为主患者栓子的CT值更高[42(32,53)比36(31,41),Z=-2.003,P=0.045],取栓次数更少[2(1,2)比3(2,4),Z=-7.613,P<0.001],手术时间更短[45(30,60)min比80(60,90)min,Z=-6.944,P<0.001],临床预后更好[改良Rankin量表评分≤2分的患者比例:62.7%(37/59)比39.2%(31/79),χ^(2)=7.444,P=0.006]。两组间患者血管闭塞的部位无明显差异。结论血栓成分主要是红细胞的患者卒中的病因是非心源性脑栓塞的可能性更大,栓子的CT值也相对较高,栓子更易取出,且临床预后相对较好。Objective To evaluate the association between thrombus composition and mechanical recanalization,operation procedure and clinical outcome.Methods One hundred and ninety-two consecutive stroke patients with large-vessel occlusion treated by mechanical thrombectomy using a stent retriever and(or)aspiration catheter in the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University between January 2018 and January 2020 were collected.The retrieved thrombi were quantitatively analyzed for red blood cells,white blood cells,platelets,and fibrin.The patients were divided into two groups,a erythrocyte-rich group and a fibrin-rich group based on the predominant composition in the clot.The clinical prognosis,CT value of thrombus,procedure time,number of recanalization maneuvers,and degree of vascular recanalization were compared between the two groups.Results The retrieved clot from 138 patients with acute ischemic stroke from internal carotid artery occlusion(n=56),middle cerebral artery occlusion(n=62),intracranial segment of vertebral artery or basilar artery occlusion(n=20)were histologically analyzed.Erythrocyte-rich clots were present in 59 cases,while fibrin-rich clots were present in 79 cases.Cardioembolic thrombi had higher proportions of fibrin/platelets[77.2%(61/79)],less erythrocytes than noncardioembolic thrombi[45.8%(27/59),χ^(2)=8.115,P=0.004].Patients with erythrocyte-rich thrombi had a smaller number of recanalization maneuvers[2(1,2)vs 3(2,4),Z=-7.613,P<0.001],shorter procedure time[45(30,60)min vs 80(60,90)min,Z=-6.944,P<0.001],higher thrombus CT value[42(32,53)vs 36(31,41),Z=-2.003,P=0.045],good clinical prognosis(the ratio of modified Rankin Scale score≤2,62.7%(37/59)vs 39.2%(31/79),χ^(2)=7.444,P=0.006).There was no significant difference in the location of vascular occlusion between the two groups.Conclusion For patients whose thrombotic components are mainly red blood cells,the cause of stroke may be non cardiogenic cerebral embolism,the CT value of embolus is relatively high,the emb

关 键 词：卒中 脑缺血 机械取栓 病理 栓子组成 

分 类 号：R743.3[医药卫生—神经病学与精神病学]