Akut iskemik inmede trombüs histopatolojisi ile görüntüleme özellikleri ve inme etiyolojisi arasındaki ilişkinin belirlenmesi
Küçük Resim Yok
Dosyalar
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Mekanik trombektomi uygulanmış hastalarda pıhtıya ait görüntüleme özelliklerinin ve pıhtının histopatolojik özelliklerinin tanımlanması inme etiyolojisi ve ideal tedavi stratejileri hakkında fikir verebilir. Bu çalışmada pıhtının histopatolojik bileşimi ile tanısal görüntüleme özellikleri ve olası inme etiyolojisi arasındaki ilişkinin araştırılması amaçlanmıştır. GEREÇ VE YÖNTEM: Çalışmaya Ege Üniversitesi Hastanesi’ne Ocak 2020- Ocak 2021 yılları arasında akut iskemik inme ile başvuran ve mekanik trombektomi tedavisi sonrası trombüslerin histolojik incelemeleri yapılabilen 44 hasta dahil edildi. İskemik inmenin etiyolojik sınıflaması TOAST (Akut İnme Tedavisinde Org 10172 Çalışması) kriterlerine göre yapıldı. Trombüslerin histolojik analizi hematoksilen eozin boyası kullanılarak uzman bir nöropatolog tarafından değerlendirildi. İçerikteki komponentlerin rölatif yüzdesine göre trombüsler fibrin/trombositten zengin (F/T-zengin), eritrositten zengin (ERT-zengin) veya mikst tip olarak sınıflandırıldı. Uzman bir nöroradyolog tarafından görüntülemeler üzerinden trombüslerin dansitesi ve trombüs kontrast geçirgenliği ölçümleri yapıldı. Hiperdens arter bulgusu (HAS) varlığı araştırıldı. Trombüsün geçirgenliği doğrudan ölçülemediği için geçirgenliğin bir temsilcisi olarak trombüs atenuasyon indeksi (TAİ) kullanıldı. TAİ≥10 HU olan pıhtılar geçirgen pıhtı, TAİ<10 HU olan pıhtılar ise geçirimsiz pıhtılar olarak tanımlandı. Mekanik trombektomi işlemine ait zaman parametreleri, rekanalizasyon düzeyleri ve komplikasyonlar değerlendirildi. BULGULAR: Literatürle benzer şekilde HAS varlığının ve yüksek dansite değerlerinin eritrositten zengin trombüs tipi ile ilişkili olduğu saptanmıştır. Trombüsün pre-kontrast dansite değeri ile eritrosit yüzdesi arasında zayıf düzeyde pozitif korelasyon bulunurken, post-kontrast dansite değeri ile eritrosit yüzdesi arasında orta düzeyde pozitif korelasyon olduğu görüldü. Ancak TAİ değerleri ile trombüsün komponentleri arasında anlamlı bir korelasyon saptanmadı. Eritrositten zengin trombüslerin TAİ değeri, F/T’ten zengin trombüslerin TAİ değerinden daha yüksekti. Ancak istatistiksel olarak anlamlı bir ilişki saptanmadı. Bunun yanında geçirgen pıhtıların (TAİ≥10) geçirimsiz pıhtılara (TAİ<10) kıyasla eritrosit bileşen oranlarının anlamlı düzeyde daha yüksek, fibrin/trombosit bileşen oranlarının anlamlı düzeyde daha düşük olduğu saptandı. Büyük arter aterosklerozundan (BAA) kaynaklı trombüslerin daha yüksek TAİ değerlerine sahip olduğu gözlense de etiyoloji ile TAİ arasında anlamlı bir ilişki ortaya konamamıştır. Literatürü destekler şekilde büyük arter aterosklerozu kaynaklı trombüslerin kardiyoembolik trombüslere kıyasla daha yüksek eritrosit bileşeni içerdiği gözlense de etiyolojik gruplar arasında trombüs tipleri açısından istatistiksel olarak anlamlı bir farklılık gösterilememiştir. Literatürle benzer şekilde kardiyoembolik inmelerin, BAA kaynaklı inmelere göre anlamlı düzeyde daha yüksek miktarda lökosit içeriğine sahip olduğu görüldü. SONUÇ: Çalışmamız küçük bir örneklem grubuna sahip olmasına rağmen bulgularımız literatürü destekler şekilde pıhtı histolojisinin etiyoloji ve görüntüleme özellikleri ile ilişkisini destekler bazı sonuçlara ulaşmıştır. Eritrositten zengin trombüsün yüksek dansite ve HAS varlığı ile ilişkili olduğu gözlenmiştir. Yine trombüsün lökosit içeriğinin kardiyak kökenli inmeler ile ilişkili olduğu görülmüştür. Trombüs geçirgenliğinin histoloji ile ilişkisi henüz literatürde netlik kazanmamış çelişkili sonuçlarla kuşatılmıştır. Bizim çalışmamızda da istatistiksel olarak anlamlı bir ilişki saptanamamıştır. Ancak çalışmamızın sonuçlarından elde edilen eritrositten zengin trombüslerin daha yüksek geçirgenlik düzeylerine sahip olduğu, büyük arter aterosklerozundan kaynaklı inmelerin daha yüksek eritrosit içeriklerine sahip olduğu ve büyük arter aterosklerozundan kaynaklı trombüslerin daha yüksek geçirgenlik değerlerine sahip olduğu sonuçları birlikte değerlendirildiğinde dolaylı olarak trombüs geçirgenliğinin eritrosit içeriği ile korelasyon gösterdiği öngörülebilir. Trombüsün radyolojik ve patolojik özelliklerinin ileri karakterizasyonu yapılabilirse inmenin etiyolojisi ve ideal tedavi stratejileri hakkında fikir verebilir. Ayrıca tekrarlayan inmelerin büyük bir kısmını oluşturan nedeni belirlenemeyen inme hastalarında trombüs histolojisi ve görüntüleme özellikleri kullanılarak altta yatan etiyolojiyi tahmin etmede kullanılabilir.
OBJECTIVE: The identification of imaging features and the histopathological features of the clot in patients who have undergone mechanical thrombectomy can give an idea about the etiology of stroke and ideal treatment strategies. In this study, it was aimed to investigate the relationship between the histopathological composition of the clot and radiologic imaging features & possible etiology of stroke. MATERIALS AND METHODS: Forty-four patients who applied to Ege University Hospital with acute ischemic stroke between January 2020 and January 2021 and whose histological examination of thrombi could be performed after mechanical thrombectomy treatment were included in the study. The etiological classification of ischemic stroke was made according to TOAST (Org 10172 Study in the Treatment of Acute Stroke) criteria. Histological analysis of thrombi was evaluated by a specialist neuropathologist using hematoxylin-eosin stain. Thrombi were classified as fibrin/platelet-rich (F/T-rich), erythrocyte-rich (ERT-rich) or mixed type, according to the relative percentage of the components. Density of thrombi and thrombus contrast permeability were measured by a specialist neuroradiologist. Presence of hyperdense artery sign (HAS) was investigated. Since the permeability of the thrombus could not be measured directly, the thrombus attenuation index (TAI) was used as an indicator of the permeability. Clots with TAI≥10 HU were defined as permeable clots and clots with TAI<10 HU were defined as impermeable clots. Time parameters, recanalization levels and complications of the mechanical thrombectomy procedure were evaluated. RESULTS: Similar to the literature, we found that the presence of HAS and high density values were associated with erythrocyte-rich thrombus type. While there was a weak positive correlation between the pre-contrast density value and the erythrocyte percentage of the thrombus, there was a moderate positive correlation between the post-contrast density value and the erythrocyte percentage. However, no significant correlation was found between TAI values and the components of thrombus. TAI value of erythrocyte-rich thrombi was higher than that of F/P-rich thrombi. However, no statistically significant relationship was found. In addition, permeable clots (TAI≥10) were found to have significantly higher erythrocyte component ratios and significantly lower fibrin/platelet component ratios compared to impermeable clots (TAI<10). Although it was observed that thrombi originating from large artery atherosclerosis had higher TAI values, no significant relationship could be demonstrated between etiology and TAI. Additionally it has been observed that thrombi originating from large artery atherosclerosis contain a higher erythrocyte component compared to cardioembolic thrombi, which supports the literature, but there was no significant difference between two groups in terms of thrombus types. Similar to the literature, cardioembolic strokes were found to have a significantly higher leukocyte content than large artery atherosclerosis induced strokes. CONCLUSION: Despite the small sample size of our study, our findings supported the literature and showed some results supporting the relationship of clot histology with stroke etiology and imaging features. It has been observed that erythrocyte-rich thrombus is associated with high density and the presence of HAS. It has also been observed that the leukocyte content of the thrombus is associated with strokes of cardiac origin. The relationship between thrombus permeability and histological findings is controversial and have not yet been clarified in the literature. No statistically significant relationship was found in our study either. However, when the results of our study that erythrocyte-rich thrombi have higher permeability levels, strokes from large artery atherosclerosis have higher erythrocyte contents, and thrombi from large artery atherosclerosis have higher permeability values are evaluated together, it can be foreseen that thrombus permeability is indirectly correlated with erythrocyte content. If further characterization of radiological and pathological features of thrombus can be made, it can give an idea about the etiology of stroke and ideal treatment strategies. In addition, it can be used to predict the underlying etiology by using thrombus histology and imaging features in stroke patients with undetermined etiology, which accounts for the majority of recurrent strokes.
OBJECTIVE: The identification of imaging features and the histopathological features of the clot in patients who have undergone mechanical thrombectomy can give an idea about the etiology of stroke and ideal treatment strategies. In this study, it was aimed to investigate the relationship between the histopathological composition of the clot and radiologic imaging features & possible etiology of stroke. MATERIALS AND METHODS: Forty-four patients who applied to Ege University Hospital with acute ischemic stroke between January 2020 and January 2021 and whose histological examination of thrombi could be performed after mechanical thrombectomy treatment were included in the study. The etiological classification of ischemic stroke was made according to TOAST (Org 10172 Study in the Treatment of Acute Stroke) criteria. Histological analysis of thrombi was evaluated by a specialist neuropathologist using hematoxylin-eosin stain. Thrombi were classified as fibrin/platelet-rich (F/T-rich), erythrocyte-rich (ERT-rich) or mixed type, according to the relative percentage of the components. Density of thrombi and thrombus contrast permeability were measured by a specialist neuroradiologist. Presence of hyperdense artery sign (HAS) was investigated. Since the permeability of the thrombus could not be measured directly, the thrombus attenuation index (TAI) was used as an indicator of the permeability. Clots with TAI≥10 HU were defined as permeable clots and clots with TAI<10 HU were defined as impermeable clots. Time parameters, recanalization levels and complications of the mechanical thrombectomy procedure were evaluated. RESULTS: Similar to the literature, we found that the presence of HAS and high density values were associated with erythrocyte-rich thrombus type. While there was a weak positive correlation between the pre-contrast density value and the erythrocyte percentage of the thrombus, there was a moderate positive correlation between the post-contrast density value and the erythrocyte percentage. However, no significant correlation was found between TAI values and the components of thrombus. TAI value of erythrocyte-rich thrombi was higher than that of F/P-rich thrombi. However, no statistically significant relationship was found. In addition, permeable clots (TAI≥10) were found to have significantly higher erythrocyte component ratios and significantly lower fibrin/platelet component ratios compared to impermeable clots (TAI<10). Although it was observed that thrombi originating from large artery atherosclerosis had higher TAI values, no significant relationship could be demonstrated between etiology and TAI. Additionally it has been observed that thrombi originating from large artery atherosclerosis contain a higher erythrocyte component compared to cardioembolic thrombi, which supports the literature, but there was no significant difference between two groups in terms of thrombus types. Similar to the literature, cardioembolic strokes were found to have a significantly higher leukocyte content than large artery atherosclerosis induced strokes. CONCLUSION: Despite the small sample size of our study, our findings supported the literature and showed some results supporting the relationship of clot histology with stroke etiology and imaging features. It has been observed that erythrocyte-rich thrombus is associated with high density and the presence of HAS. It has also been observed that the leukocyte content of the thrombus is associated with strokes of cardiac origin. The relationship between thrombus permeability and histological findings is controversial and have not yet been clarified in the literature. No statistically significant relationship was found in our study either. However, when the results of our study that erythrocyte-rich thrombi have higher permeability levels, strokes from large artery atherosclerosis have higher erythrocyte contents, and thrombi from large artery atherosclerosis have higher permeability values are evaluated together, it can be foreseen that thrombus permeability is indirectly correlated with erythrocyte content. If further characterization of radiological and pathological features of thrombus can be made, it can give an idea about the etiology of stroke and ideal treatment strategies. In addition, it can be used to predict the underlying etiology by using thrombus histology and imaging features in stroke patients with undetermined etiology, which accounts for the majority of recurrent strokes.
Açıklama
Anahtar Kelimeler
Anahtar kelime mevcut olmadığı için bu alan boş bırakılmıştır.
