Thrombus composition in ischaemic stroke: histological and radiological evaluation, and implications for acute clinical management.

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thrombosis and Thrombolysis Pub Date : 2025-03-01 Epub Date: 2025-03-21 DOI:10.1007/s11239-025-03074-6

Esmee Dohle, Abhishekh H Ashok, Shiv Bhakta, Isuru Induruwa, Nicholas R Evans

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Abstract

Ischaemic stroke is one of the key causes of morbidity and mortality worldwide. Although rapid reperfusion through thrombolysis or mechanical thrombectomy is the cornerstone of acute management, the efficacy of these interventions is influenced by the underlying composition of the occluding thrombus, which varies widely. Histological examination of retrieved thrombi allows the determination of thrombus composition and may inform aetiology and secondary prevention strategies. Additionally, radiological features may provide valuable pre-treatment insights into thrombus composition to help predict treatment success. This narrative review discusses histological and radiological indicators of thrombus composition, and how this may predict success of thrombolysis and thrombectomy. Furthermore, it discusses how these insights can be applied in the diagnostic work-up of embolic stroke of undetermined source (ESUS), and the potential utility of emerging biomarkers relating to thrombus formation, in order to optimise secondary prevention strategies.

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缺血性中风的血栓构成：组织学和放射学评估以及对急性期临床治疗的影响。

缺血性脑卒中是全世界发病率和死亡率的主要原因之一。虽然通过溶栓或机械取栓快速再灌注是急性治疗的基础，但这些干预措施的效果受到阻塞血栓的潜在成分的影响，这些成分的差异很大。对回收的血栓进行组织学检查，可以确定血栓的组成，并可以告知病因学和二级预防策略。此外，放射学特征可能提供有价值的治疗前洞察血栓组成，以帮助预测治疗成功。这篇叙述性的综述讨论了血栓组成的组织学和放射学指标，以及如何预测溶栓和取栓的成功。此外，它还讨论了如何将这些见解应用于不明来源栓塞性卒中（ESUS）的诊断工作，以及与血栓形成相关的新兴生物标志物的潜在效用，以优化二级预防策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thrombosis and Thrombolysis 医学-外周血管病

CiteScore

9.20

自引率

0.00%

发文量

112

审稿时长

4-8 weeks

期刊介绍： The Journal of Thrombosis and Thrombolysis is a long-awaited resource for contemporary cardiologists, hematologists, vascular medicine specialists and clinician-scientists actively involved in treatment decisions and clinical investigation of thrombotic disorders involving the cardiovascular and cerebrovascular systems. The principal focus of the Journal centers on the pathobiology of thrombosis and vascular disorders and the use of anticoagulants, platelet antagonists, cell-based therapies and interventions in scientific investigation, clinical-translational research and patient care. The Journal will publish original work which emphasizes the interface between fundamental scientific principles and clinical investigation, stimulating an interdisciplinary and scholarly dialogue in thrombosis and vascular science. Published works will also define platforms for translational research, drug development, clinical trials and patient-directed applications. The Journal of Thrombosis and Thrombolysis'' integrated format will expand the reader''s knowledge base and provide important insights for both the investigation and direct clinical application of the most rapidly growing fields in medicine-thrombosis and vascular science.