Relationship Between Thrombus Composition And Prognosis In Patients With Acute Cerebral Infarction

Objective:To analyze the correlation between thrombus composition and prognosis of patients with acute cerebral infarction after stenting retrievers;And explore the efficacy of intravenous thrombolysis with rt-PA on operative recanalization time.Methods:1.We retrospectively analyze the clinical data of 48 patients with acute ischemic stroke who received intravascular mechanical thrombectomy and recanalization treatment in the first affiliated hospital of army medical university from June 2015 to February 2019,including: name,sex,age,hypertension,diabetes mellitus,atrial fibrillation,coronary atherosclerotic heart disease,hyperlipidemia,hyperhomocysteinemia,cerebral infarction history,smoking and drinking history;Stroke etiology according to TOAST criteria,occlusion site,intravenous thrombolysis with or without rt-PA,number of recanalization maneuvers,recanalization time,TICI score,number and type of stent used,complications,and other factors;ASPECTS,NIHSS score,mRS score at 3 months;Brain CT plain scan,head and neck CTA,brain MRI or MRA,neck vascular ultrasound,electrocardiogram,etc.2.The thrombus material was fixed in 4% neutralized buffered formalin immediately after retrieval,and then paraffin embedded.All thrombi were stained with hematoxylin-eosin.The slides with the stained specimens were scanned under microscope and digitally stored.The differences of thrombus composition which have different sources were analyzed.3.The prognosis of patients treated with intravascular mechanical thrombolysis was timely and effectively followed up.Patients were divided into the group with Fibrin/platelet-rich thrombi and the group with erythrocyte-rich thrombi.The prognosis of the two groups were compared(based on mRS score at 3 months: good prognosis with mRS score at 0-2;poor prognosis with mRS score at 3-6).4.Patients were divided into groups according to whether patients were treated with rt-PA intravenous thrombolysis before intravascular mechanical thrombolysis,and the recanalization time of the two groups was compared.5.T test,chi-square test and other statistical methods are used to analyze the relevant data.Results:1.48 patients were included,of these,in 24 patients,cardioembolic;in 16 patients,large atherosclerotic;and in 8 patients,cryptogenic pathogenesis was determined.There was a significant difference in the ratio of fibrin/platelet in between cardiogenic thrombus and large atherosclerotic thrombus [(62.9 ± 15.9)vs(50.9 ± 14.1)] %,P < 0.05;2.Fibrin/platelet-rich thrombi were present in 35 cases,while erythrocyte-rich thrombi were present in 13 cases.Patients with the thrombus rich in fibrin/platelet showed lower mRS score at end of the third month than thrombus rich in erythrocyte [26 vs 62] %,P < 0.05;3.The recanalization time for the mechanical thrombectomy in patients received intravenous thrombolysis with rt-PA was significantly less than that without rt-PA intravenous thrombolysis [(90 ± 47.6)vs(131.6 ± 57.5)] min,P < 0.05.Conclusion:1.Cardiogenic thrombus has a higher content of fibrin/platelet and a lower content of red blood cells than atherosclerotic thrombus.2.Patients with thrombus rich in fibrin/platelets have worse prognosis than those with thrombus rich in erythrocytes.3.In all patients who use intravenous thrombolysis with rt-PA before intravascular mechanical thrombolysis reduce the procedure time.