急性缺血性脑卒中颅内血栓病理研究进展
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摘要
急性缺血性脑卒中(AIS)占新发脑卒中总体的69. 6%～70. 8%。血管内治疗可去除闭塞颅内大血管的血栓和改善患者预后。分析颅内血栓的组成成分、来源、物理特性及其与血管之间的相互作用有助于判定AIS开通策略、临床预后、病因及二级预防。该文综述了近年来发表的有关AIS颅内血栓的研究文献,指出了未来该领域内的部分研究方向。
Acute ischemic stroke(AIS) accounts for 69. 6% ～ 70. 8% of all new stroke cases. Endovascular thrombectomy(ET) can remove the thrombi from occluded intracranial large vessels and improve the outcome of AIS.The components,sources,physical characteristics of intracranial thrombi and their interactions with blood vessels might be helpful for the judgement of recanalization strategies,clinical prognosis,etiology and secondary prevention.This review summarizes the literatures published in recent years and predicts some further researches of this field in the future.
Acute ischemic stroke(AIS) accounts for 69. 6% ～ 70. 8% of all new stroke cases. Endovascular thrombectomy(ET) can remove the thrombi from occluded intracranial large vessels and improve the outcome of AIS.The components,sources,physical characteristics of intracranial thrombi and their interactions with blood vessels might be helpful for the judgement of recanalization strategies,clinical prognosis,etiology and secondary prevention.This review summarizes the literatures published in recent years and predicts some further researches of this field in the future.
引文
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2 Liu L,Wang D,Wong KS,et al.Stroke and stroke care in China:huge burden,significant workload,and a national priority[J].Stroke,2011,42(12):3651-3654.
3 Wang D,Liu J,Liu M,et al.Patterns of Stroke Between University Hospitals and Nonuniversity Hospitals in Mainland China:Prospective Multicenter Hospital-Based Registry Study[J].World Neurosurg,2017,98:258-265.
4 Wang W,Jiang B,Sun H,et al.Prevalence,Incidence,and Mortality of Stroke in China:Results from a Nationwide Population-Based Survey of 480687 Adults[J].Circulation,2017,135(8):759-771.
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6 Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl JMed,2015,372(11):1009-1018.
7 Goyal M,Demchuk AM,Menon BK,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].N Engl JMed,2015,372(11):1019-1030.
8 Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8 hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372(24):2296-2306.
9 Saver JL,Goyal M,Bonafe A,et al.Stent-retriever thrombectomy after intravenous t-PA vs.t-PA alone in stroke[J].N Engl J Med,2015,372(24):2285-2295.
10 Albers GW,Marks MP,Kemp S,et al.Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging[J].N Engl JMed,2018,378(8):708-718.
11 Nogueira RG,Jadhav AP,Haussen DC,et al.Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct[J].N Engl J Med,2018,378(1):11-21.
12李家增,贺石林,王鸿利,等.临床血栓病学[M].上海:上海交通大学出版社,2014:84-165.
13 Marder VJ,Chute DJ,Starkman S,et al.Analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke[J].Stroke,2006,37(8):2086-2093.
14 Chueh JY,Wakhloo AK,Hendricks GH,et al.Mechanical characterization of thromboemboli in acute ischemic stroke and laboratory embolus analogs[J].AJNR Am J Neuroradiol,2011,32(7):1237-1244.
15 Boeckh-Behrens T,Schubert M,F9rschler A,et al.The Impact of Histological Clot Composition in Embolic Stroke[J].Clin Neuroradiol,2016,26(2):189-197.
16 Choi MH,Park GH,Lee JS,et al.Erythrocyte Fraction Within Retrieved Thrombi Contributes to Thrombolytic Response in Acute Ischemic Stroke[J].Stroke,2018,49(3):652-659.
17 Singh P,Doostkam S,Reinhard M,et al.Immunohistochemical analysis of thrombi retrieved during treatment of acute ischemic stroke:does stent-retriever cause intimal damage?[J].Stroke,2013,44(6):1720-1722.
18 Simons N,Mitchell P,Dowling R,et al.Thrombus composition in acute ischemic stroke:a histopathological study of thrombus extracted by endovascular retrieval[J].J Neuroradiol,2015,42(2):86-92.
19 Schuhmann MK,Gunreben I,Kleinschnitz C,et al.Immunohistochemical Analysis of Cerebral Thrombi Retrieved by Mechanical Thrombectomy from Patients with Acute Ischemic Stroke[J].Int JMol Sci,2016,17(3):298.
20 Dargazanli C,Rigau V,Eker O,et al.High CD3+Cells in Intracranial Thrombi Represent a Biomarker of Atherothrombotic Stroke[J].PLo S One,2016,11(5):e0154945.
21 Sporns PB,Hanning U,Schwindt W,et al.Ischemic Stroke:What Does the Histological Composition Tell Us About the Origin of the Thrombus?[J].Stroke,2017,48(8):2206-2210.
22 Autar ASA,Hund HM,Ramlal SA,et al.High-Resolution Imaging of Interaction Between Thrombus and Stent-Retriever in Patients With Acute Ischemic Stroke[J].J Am Heart Assoc,2018,7(13):pii:e008563.
23 Hashimoto T,Hayakawa M,Funatsu N,et al.Histopathologic Analysis of Retrieved Thrombi Associated With Successful Reperfusion After A-cute Stroke Thrombectomy[J].Stroke,2016,47(12):3035-3037.
24 Hernández-Fernández F,Rojas-BartoloméL,García-García J,et al.Histopathological and Bacteriological Analysis of Thrombus Material Extracted During Mechanical Thrombectomy in Acute Stroke Patients[J].Cardiovasc Intervent Radiol,2017,40(12):1851-1860.
25宋朝阳,朱良付,李天晓,等.急性缺血性卒中血管内治疗血栓标本胆固醇结晶分析[J].中国现代神经疾病杂志,2018,18(5):360-365.
26 Niesten JM,van der Schaaf IC,van Dam L,et al.Histopathologic composition of cerebral thrombi of acute stroke patients is correlated with stroke subtype and thrombus attenuation[J].PLo S One,2014,9(2):e88882.
27 De Meyer SF,Andersson T,Baxter B,et al.Analyses of thrombi in acute ischemic stroke:A consensus statement on current knowledge and future directions[J].Int J Stroke,2017,12(6):606-614.
28 Brinjikji W,Duffy S,Burrows A,et al.Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome:a systematic review[J].J Neurointerv Surg,2017,9(6):529-534.
29 Kim SK,Yoon W,Kim TS,et al.Histologic Analysis of Retrieved Clots in Acute Ischemic Stroke:Correlation with Stroke Etiology and GradientEcho MRI[J].AJNR Am J Neuroradiol,2015,36(9):1756-1762.
30 Almekhlafi MA,Hu WY,Hill MD,et al.Calcification and endothelialization of thrombi in acute stroke[J].Ann Neurol,2008,64(3):344-348.
31 Maekawa K,Shibata M,Nakajima H,et al.Erythrocyte-Rich Thrombus Is Associated with Reduced Number of Maneuvers and Procedure Time in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy[J].Cerebrovasc Dis Extra,2018,8(1):39-49.
32 Liebeskind DS,Sanossian N,Yong WH,et al.CT and MRI early vessel signs reflect clot composition in acute stroke[J].Stroke,2011,42(5):1237-1243.
33 Zhu L,Shao Q,Li T,et al.Evaluation of the JRecan device for thrombus retrieval:efficacy and safety in a swine model of acute arterial occlusion[J].J Neurointerv Surg,2016,8(5):526-530.
34 Shao Q,Zhu L,Li T,et al.New method of thrombus preparation using a fluid model for evaluation of thrombectomy devices in a swine model[J].Thromb Res,2014,134(5):1087-1092.
35 Denorme F,Langhauser F,Desender L,et al.ADAMTS13-mediated thrombolysis of t-PA-resistant occlusions in ischemic stroke in mice[J].Blood,2016,127(19):2337-2345.
36 Ohshima T,Goto S,Yamamoto T,et al.Experimental evaluation and training of stent clot retrieval:the confront clot scrambling method[J].Nagoya J Med Sci,2017,79(3):401-406.
2 Liu L,Wang D,Wong KS,et al.Stroke and stroke care in China:huge burden,significant workload,and a national priority[J].Stroke,2011,42(12):3651-3654.
3 Wang D,Liu J,Liu M,et al.Patterns of Stroke Between University Hospitals and Nonuniversity Hospitals in Mainland China:Prospective Multicenter Hospital-Based Registry Study[J].World Neurosurg,2017,98:258-265.
4 Wang W,Jiang B,Sun H,et al.Prevalence,Incidence,and Mortality of Stroke in China:Results from a Nationwide Population-Based Survey of 480687 Adults[J].Circulation,2017,135(8):759-771.
5 Berkhemer OA,Fransen PS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].N Engl J Med,2015,372(1):11-20.
6 Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl JMed,2015,372(11):1009-1018.
7 Goyal M,Demchuk AM,Menon BK,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].N Engl JMed,2015,372(11):1019-1030.
8 Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8 hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372(24):2296-2306.
9 Saver JL,Goyal M,Bonafe A,et al.Stent-retriever thrombectomy after intravenous t-PA vs.t-PA alone in stroke[J].N Engl J Med,2015,372(24):2285-2295.
10 Albers GW,Marks MP,Kemp S,et al.Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging[J].N Engl JMed,2018,378(8):708-718.
11 Nogueira RG,Jadhav AP,Haussen DC,et al.Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct[J].N Engl J Med,2018,378(1):11-21.
12李家增,贺石林,王鸿利,等.临床血栓病学[M].上海:上海交通大学出版社,2014:84-165.
13 Marder VJ,Chute DJ,Starkman S,et al.Analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke[J].Stroke,2006,37(8):2086-2093.
14 Chueh JY,Wakhloo AK,Hendricks GH,et al.Mechanical characterization of thromboemboli in acute ischemic stroke and laboratory embolus analogs[J].AJNR Am J Neuroradiol,2011,32(7):1237-1244.
15 Boeckh-Behrens T,Schubert M,F9rschler A,et al.The Impact of Histological Clot Composition in Embolic Stroke[J].Clin Neuroradiol,2016,26(2):189-197.
16 Choi MH,Park GH,Lee JS,et al.Erythrocyte Fraction Within Retrieved Thrombi Contributes to Thrombolytic Response in Acute Ischemic Stroke[J].Stroke,2018,49(3):652-659.
17 Singh P,Doostkam S,Reinhard M,et al.Immunohistochemical analysis of thrombi retrieved during treatment of acute ischemic stroke:does stent-retriever cause intimal damage?[J].Stroke,2013,44(6):1720-1722.
18 Simons N,Mitchell P,Dowling R,et al.Thrombus composition in acute ischemic stroke:a histopathological study of thrombus extracted by endovascular retrieval[J].J Neuroradiol,2015,42(2):86-92.
19 Schuhmann MK,Gunreben I,Kleinschnitz C,et al.Immunohistochemical Analysis of Cerebral Thrombi Retrieved by Mechanical Thrombectomy from Patients with Acute Ischemic Stroke[J].Int JMol Sci,2016,17(3):298.
20 Dargazanli C,Rigau V,Eker O,et al.High CD3+Cells in Intracranial Thrombi Represent a Biomarker of Atherothrombotic Stroke[J].PLo S One,2016,11(5):e0154945.
21 Sporns PB,Hanning U,Schwindt W,et al.Ischemic Stroke:What Does the Histological Composition Tell Us About the Origin of the Thrombus?[J].Stroke,2017,48(8):2206-2210.
22 Autar ASA,Hund HM,Ramlal SA,et al.High-Resolution Imaging of Interaction Between Thrombus and Stent-Retriever in Patients With Acute Ischemic Stroke[J].J Am Heart Assoc,2018,7(13):pii:e008563.
23 Hashimoto T,Hayakawa M,Funatsu N,et al.Histopathologic Analysis of Retrieved Thrombi Associated With Successful Reperfusion After A-cute Stroke Thrombectomy[J].Stroke,2016,47(12):3035-3037.
24 Hernández-Fernández F,Rojas-BartoloméL,García-García J,et al.Histopathological and Bacteriological Analysis of Thrombus Material Extracted During Mechanical Thrombectomy in Acute Stroke Patients[J].Cardiovasc Intervent Radiol,2017,40(12):1851-1860.
25宋朝阳,朱良付,李天晓,等.急性缺血性卒中血管内治疗血栓标本胆固醇结晶分析[J].中国现代神经疾病杂志,2018,18(5):360-365.
26 Niesten JM,van der Schaaf IC,van Dam L,et al.Histopathologic composition of cerebral thrombi of acute stroke patients is correlated with stroke subtype and thrombus attenuation[J].PLo S One,2014,9(2):e88882.
27 De Meyer SF,Andersson T,Baxter B,et al.Analyses of thrombi in acute ischemic stroke:A consensus statement on current knowledge and future directions[J].Int J Stroke,2017,12(6):606-614.
28 Brinjikji W,Duffy S,Burrows A,et al.Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome:a systematic review[J].J Neurointerv Surg,2017,9(6):529-534.
29 Kim SK,Yoon W,Kim TS,et al.Histologic Analysis of Retrieved Clots in Acute Ischemic Stroke:Correlation with Stroke Etiology and GradientEcho MRI[J].AJNR Am J Neuroradiol,2015,36(9):1756-1762.
30 Almekhlafi MA,Hu WY,Hill MD,et al.Calcification and endothelialization of thrombi in acute stroke[J].Ann Neurol,2008,64(3):344-348.
31 Maekawa K,Shibata M,Nakajima H,et al.Erythrocyte-Rich Thrombus Is Associated with Reduced Number of Maneuvers and Procedure Time in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy[J].Cerebrovasc Dis Extra,2018,8(1):39-49.
32 Liebeskind DS,Sanossian N,Yong WH,et al.CT and MRI early vessel signs reflect clot composition in acute stroke[J].Stroke,2011,42(5):1237-1243.
33 Zhu L,Shao Q,Li T,et al.Evaluation of the JRecan device for thrombus retrieval:efficacy and safety in a swine model of acute arterial occlusion[J].J Neurointerv Surg,2016,8(5):526-530.
34 Shao Q,Zhu L,Li T,et al.New method of thrombus preparation using a fluid model for evaluation of thrombectomy devices in a swine model[J].Thromb Res,2014,134(5):1087-1092.
35 Denorme F,Langhauser F,Desender L,et al.ADAMTS13-mediated thrombolysis of t-PA-resistant occlusions in ischemic stroke in mice[J].Blood,2016,127(19):2337-2345.
36 Ohshima T,Goto S,Yamamoto T,et al.Experimental evaluation and training of stent clot retrieval:the confront clot scrambling method[J].Nagoya J Med Sci,2017,79(3):401-406.