Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study
Aglae Velasco Gonzalez, Cristina Sauerland, Dennis Görlich, Joaquin Ortega-Quintanilla, Astrid Jeibmann, Andreas Faldum, Werner Paulus, Walter Heindel, Boris Buerkedoi: 10.1136/svn-2023-003024
Stroke & Vascular Neurology（SVN）新近上线文章“Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study”，来自德国明斯特大学医院（University Hospital of Münster）神经放射科Aglae Velasco Gonzalez等。作者团队探究了通过交通动脉与主动脉上血管（supra-aortic vessel, SAV）通畅性相关的颅内栓子分布的差异。在这项实验性分析中，作者团队使用生理脉动流下的模拟血液流体创建了颅外和颅内循环的硅胶模型。观察了通过右侧颈内动脉（CA）注射104个易碎血栓模拟物（406个栓子）时SAV通畅程度发生变化时的栓子沉积顺序：（a）所有SAV通畅（基线），（b）来自CA闭塞的栓子，（c）CA闭塞对侧的栓子和（d）后循环闭塞。统计分析包括闭塞后血栓位置的描述性分析（绝对频率和相对频率）。四种SAV状态下的闭塞顺序以Sankey流程图显示。通过Fisher精确检验测评SAV状态与闭塞位置之间的关联。双侧p值以显著性水平0.05进行比较。研究结果显示，栓子总数为406个（中位数碎片/凝块：4 (IQR: 3–5)）。栓子滞留取决于SAV的通畅性（p<0.0001）。在所有情况下，栓子滞留于大脑前动脉（ACA）均发生在先前的大脑中动脉（MCA）栓塞之后（MCA首次滞留：96%, 100/104）。在基线情况下，同侧ACA栓塞的发生率为28.9%（28/97），当栓子源自闭塞的CA时，此比率显著降低（16%, 14/88）。对侧CA闭塞病例中，双侧大脑半球栓塞更多（37%, 45/122），56%的病例中双侧ACA栓塞先于对侧MCA栓塞（14/25 对侧MCA和ACA栓塞）。Figure 1. Sequential lodges by the 406 total emboli for the four anatomical conditions of the supra-aortic vessels tested. After fragmentation, the median number of lodgments per clot was four, with a minimum of 1 and a maximum of 8. The number indicated over each graphic (ranging from 1 to 8) is the sequential number of lodgments referred to in that chart. See the online supplemental table S1 for a more detailed description.
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Figure 2. Sankey flow diagrams of sequential embolic lodgments by anatomical condition of the supra-aortic vessels. The diagram shows the flows and their relative quantities in proportion to each other. Vertical coloured lines represent each lodgment (first, second, third, etc). Horizontal flow lines represent the relative quantity of fragments anchored at a particular intracranial location after a specific prior clot allocation. Emboli that migrated to the opposite hemisphere are shown in blue. Emboli that travelled to the ipsilateral ACA are shown in green. (A) Baseline: supra-aortic vessels without occlusion (97 emboli from 29 injected clots); (B) Emboli from an occluded right CA (88/25); (C) Emboli through the right CA with occlusion of the left CA (122/24); (D) Emboli through the right CA with concomitant occlusion of both vertebral arteries (99/26).
研究结论：ACA的所有栓塞均发生在先前同侧MCA栓塞之后。双侧大脑半球栓塞很少见，除非任一CA同时存在闭塞，尤其是在对侧CA闭塞的情况下。更多内容详见文章原文：https://svn.bmj.com/content/early/2024/05/23/svn-2023-003024，或点击文末“阅读原文”。投稿 / 转载 / 商务合作：csa.svn@chinastroke.netEmail：csa.svn@chinastroke.net地址：北京市丰台区南四环西路119号B区1号楼508室本公众号对其刊载的所有内容，包括文字、图片、音视频资料以及版式设计等享有版权，未经本公众号授权同意，其他任何机构不得以任何形式侵犯本公众号作品著作权，包括但不限于：擅自复制、链接、非法使用或转载，或以任何方式建立作品镜像。转载请联系后台或邮箱。如获转载授权，发布请注明出处，不得擅自修改文章内容
