| Objective:Thrombosis in patients with acute ischemic stroke have a high heterogeneity in composition.Analysis of the composition of thrombus may help predict the cause.The relationship between thrombotic components and imaging features,clinical efficacy and prognosis remains unclear.The purpose of this study was to investigate the relationship between thrombotic components and hyperdense artery sign in patients with different types of ischemic stroke,and to analyze the relationship between thrombotic components and clinical efficacy and prognosis.Methods:A retrospective analysis was performed on patients with acute ischemic stroke who received mechanical thrombectomy in stroke Center of the First Hospital of Jilin University from October 2017 to June 2020.1)Hematoxylin-eosin（HE）staining was performed on the thrombi obtained in the process of mechanical thrombolectomy,and quantitative analysis was performed on erythrocytes,white blood cells,fibrin/platelets in the thrombi.Based on the proportion of cells in the samples,the thrombus samples were divided into rich red blood cell group（proportion of red blood cell ≥ 50%）and rich fibrin group（the sum of fibrin and platelet components ≥ 50%）.Chi-square test was used to compare the differences in clinical characteristics between the two groups.Univariate binary logistic regression was used to study the factors that might lead to different components of thrombus.2)Based on TOSAT classification criteria,patients were divided into major atherosclerotic stroke group,cardiogenic cerebral embolism group,stroke of unknown cause group and stroke caused by other causes group according to different etiology.Mann-Whitney U test was used to detect the relationship between the etiology of stroke and thrombotic components.3)Non-contrast enhanced computerized tomography（NCCT）is performed before endovascular therapy to determine whether patients have Hyperdense artery sign（HAS）.The group was divided into Positive-HAS（P-HAS）groups and Negative-HAS（N-HAS）groups.The relationship between the expression of HAS on NCCT and the components of thrombus was detected by Mann-Whitney U test.4)The Modified Rankin Scale（m RS）was used to evaluate the functional recovery of ischemic stroke patients 90 days after discharge.m RS 0-2 was classified as a good prognosis and m RS 3-6 was classified as a poor prognosis.Spearman correlation analysis was used to analyze the correlation between thrombosis components and clinical data such as surgery and prognosis.Multivariate binary logistic regression equation was used to determine independent risk factors for good prognosis at 90 days after discharge.ROC were used to obtain the optimal cut-off values of thrombocytes and fibrin/platelet ratios for differentiating good and bad outcomes at 90 days.Results:A total of 98 patients eligible for inclusion were included in this study.1)Among the thrombus collected in this study,the proportion of red blood cells,white blood cells and fibrin/platelet was 41.8%（26.9%-53.6%）,3.0%（1.9%-4.2%）and 53.8%（42.7%-70.4%）,respectively.There were 40 cases of erythrocyte rich thrombus and 58 cases of fibrin rich thrombus.There was a higher rate of dyslipidemia in patients with erythroidrich thrombosis compared with patients with fibrin-rich thrombosis（22.5% vs 3.4%,P=0.03）.There were differences in stroke types between the two groups,with a higher incidence of cardiogenic embolism in the fibrin-rich thrombi group（77.6% vs 57.5%,P =0.034）.Previous dyslipidemia may affect the proportion of erythrocytes in thrombi（OR=8.129,95%CI: 1.65-40.01,P =0.01）.2)25 cases（25.5%）were atherosclerotic stroke,68 cases（69.4%）were cardiogenic cerebral embolism,4 cases（4.1%）were unknown stroke,and 1 case（1%）had other causes of stroke.Compared with patients with large atherosclerotic stroke,thromboembolic patients had a lower RBC ratio（40.5%vs 54.3%,P =0.022）and a higher fibrin/platelet ratio（57.6% vs 43.8%,P =0.018）.3)The proportion of erythrocytes in P-HAS group was higher than that in N-HAS group（50.8% vs 23.0%,P < 0.01）,while the fibrin/platelet ratio in N-HAS group was significantly higher than that in P-HAS group（74.5% vs 48.1%,P < 0.01）.4)There were no significant differences in thrombectomy and recanalization between the erythrocyte rich thrombus group and the fibrin rich thrombus group.Patients in the erythroid-rich thrombus group were more likely to have a favorable outcome than those in the fibrin-rich thrombus group（52.5% vs.31.0%,P=0.033）.Patients with good prognosis may have a higher RBC ratio（r=0.205,P=0.043）and a lower fibrin/platelet ratio（r=-0.218,P=0.031）.Vascular occlusion,time from onset to femoral artery puncture and type of thrombus were independent prognostic factors（P < 0.05）.Each 1-minute increase in the time from onset to femoral artery puncture was associated with a 1.005-fold increased risk of adverse outcome.Patients with internal carotid artery occlusion and patients with middle cerebral artery occlusion were 23.766（P=0.004）and 12.616（P=0.022）times more likely to have a favorable outcome than those with vertebrobasilar artery occlusion,respectively.The odds of a favorable outcome were3.289 times higher in the erythroid-rich thrombus group than in the fibrin-rich thrombus group（P=0.026）.The ratio of thrombotic erythrocyte（50.2%）and fibrin（50.3%）were the best cut-off values to distinguish good prognosis from bad prognosis.Conclusion:1.There were differences in thrombotic components among patients with different types of ischemic stroke.Compared with patients with major atherosclerotic stroke,thromboembolic patients had a lower RBC ratio and a higher fibrin/platelet ratio.2.There were differences in the composition of thrombus between the N-HAS group and the P-HAS group.Compared with N-HAS group,P-HAS group had higher RBC ratio and lower fibrin/platelet ratio.3.Patients with erythrocyte-rich thrombosis had a higher percentage of dyslipidemia than those with fibrin-rich thrombosis.Past dyslipidemia may influence thrombotic composition.The etiology of stroke was different between the two groups.4.No correlation was found between thrombus components and mechanical thrombectomy.5.Patients in the erythrocyte rich thrombus group had a higher percentage of favorable outcomes than those in the fibrin-rich thrombus group.Patients with a favorable prognosis may have a higher RBC ratio and a lower fibrin/platelet ratio in the thrombus.Occlusive blood vessel,time from onset to femoral artery puncture and type of thrombus were independent factors influencing prognosis. |
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