BACKGROUND AND PURPOSE There is still much debate whether bridging-therapy [intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT)] might be beneficial compared to MT alone. We investigated the effect of IVT on size and histological composition of the clots retrieved from patients undergoing bridging-therapy or MT alone. METHODS We collected mechanically extracted thrombi from 1000 acute ischemic stroke (AIS) patients included in RESTORE registry. Patients were grouped according to the administration (or not) of IVT before thrombectomy. Gross photos of each clot were taken and Extracted Clot Area (ECA) was measured using ImageJ software. Martius Scarlett Blue stain was used to characterize the main histological clot components [red blood cells (RBCs), fibrin (FIB), platelets/other (PTL)] and Orbit Image Analysis was used for quantification. Additionally, we calculated the area of each main component by multiplying the component percent by ECA. Chi-squared and Kruskal-Wallis tests were used for statistical analysis. RESULTS 451 patients (45%) were treated with bridging-therapy while 549 (55%) underwent MT alone. When considering only percent histological composition, we did not find any difference in RBC% (P = 0.895), FIB% (P = 0.458) and PTL% (P = 0.905). However, bridging-therapy clots were significantly smaller than MT-alone clots [32.7 (14.8-64.9) versus 36.8 (20.1-79.8) mm2, N = 1000, H1 = 7.679, P = 0.006*]. A further analysis expressing components per clot area showed that clots retrieved from bridging-therapy cases contained less RBCs [13.25 (4.29-32.06) versus 14.97 (4.93-39.80) mm2, H1 = 3.637, P = 0.056] and significantly less fibrin [9.10 (4.62-17.98) versus 10.54 (5.57-22.48) mm2, H1 = 7.920, P = 0.005*] and platelets/other [5.04 (2.26-11.32) versus 6.54 (2.94-13.79) mm2, H1 = 9.380, P = 0.002*] than MT-alone clots. CONCLUSIONS Our results suggest that previous IVT administration significantly reduces thrombus size, proportionally releasing all the main histological components.

中文翻译：

---

先前给予 rtPA 是否会影响急性缺血性中风血栓成分？对 RESTORE 登记处通过机械血栓切除术回收的血栓进行分析的结果。


背景和目的 与单独的 MT 相比，桥接疗法 [机械血栓切除术 (MT) 之前的静脉溶栓 (IVT)] 是否有益仍存在很多争论。我们研究了 IVT 对从接受桥接治疗或单独 MT 的患者中取出的血栓大小和组织学成分的影响。方法 我们从 RESTORE 登记中纳入的 1000 名急性缺血性中风 (AIS) 患者中收集了机械提取的血栓。根据血栓切除术前是否进行 IVT 对患者进行分组。拍摄每个血块的大体照片并使用 ImageJ 软件测量提取的血块面积 (ECA)。使用 Martius Scarlett Blue 染色来表征主要的组织学凝块成分 [红细胞 (RBC)、纤维蛋白 (FIB)、血小板/其他 (PTL)]，并使用轨道图像分析进行定量。此外，我们通过将成分百分比乘以 ECA 来计算每个主要成分的面积。卡方检验和 Kruskal-Wallis 检验用于统计分析。结果 451 名患者 (45%) 接受了桥接治疗，而 549 名患者 (55%) 只接受了 MT。当仅考虑组织学组成百分比时，我们没有发现 RBC% (P = 0.895)、FIB% (P = 0.458) 和 PTL% (P = 0.905) 存在任何差异。然而，桥接治疗的血栓明显小于单独 MT 的血栓 [32.7 (14.8-64.9) vs 36.8 (20.1-79.8) mm2，N = 1000，H1 = 7.679，P = 0.006*]。表达每个凝块面积成分的进一步分析表明，从桥接治疗病例中回收的凝块含有较少的红细胞 [13.25 (4.29-32.06) 与 14.97 (4.93-39.80) mm2，H1 = 3.637，P = 0.056] 和显着较少的纤维蛋白 [9.10 (4.62-17.98) 与 10.54 (5.57-22.48) mm2，H1 = 7.920，P = 0.005*] 和血小板/其他 [5.04 (2.26-11.32) 与 6.54 (2.94-13.79) mm2，H1 = 9.380，P = 0.002*] 相比，单独使用 MT 的血栓。结论 我们的结果表明，先前的 IVT 给药显着减少了血栓大小，按比例释放了所有主要组织学成分。