transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2026-18-1-67-79transplantologiya-1078Research ArticleПРОБЛЕМНЫЕ АСПЕКТЫPROBLEMATIC ASPECTSГистологический анализ тромбов в дифференциальной диагностике подтипов ишемического инсультаHistological analysis of thrombi for differential diagnosis of ischemic stroke subtypeshttps://orcid.org/0000-0002-5844-1648КомароваА. Г.KomarovaA. G.

Анна Григорьевна Комарова, канд. мед. наук, заместитель главного врача по медицинской части (РСЦ)

125284, Москва, 2-й Боткинский пр-д, д. 5

Anna G. Komarova, Cand. Sci. (Med.), Head of Regional Vascular Center

5 2nd Botkinskiy Dr., Moscow 125284

bellis-06@mail.ruhttps://orcid.org/0000-0003-3929-431XШаваровА. А.ShavarovA. A.

Андрей Анатольевич Шаваров, доц., канд. мед. наук, старший научный сотрудник отдела Наука

125284, Москва, 2-й Боткинский пр-д, д. 5

Andrey A. Shavarov, Assoc. Prof., Cand. Sci. (Med.), Senior Researcher, Science Department

5 2nd Botkinskiy Dr., Moscow 125284

shavarov@yahoo.comhttps://orcid.org/0000-0001-8613-9609ЗакурдаевЕ. И.ZakurdaevE. I.

Евгений Иванович Закурдаев, канд. мед. наук, врач патологоанатом, ответственный за биопсийный раздел работы патолого-анатомического отделения

125284, Москва, 2-й Боткинский пр-д, д. 5

Eugeniy I. Zakurdaev, Cand. Sci. (Med.), Forensic Pathologist, Responsible for Biopsy Section, Pathology Department

5 2nd Botkinskiy Dr., Moscow 125284

https://orcid.org/0000-0002-6903-9996ЕрошкинК. Е.EroshkinK. E.

Кирилл Евгеньевич Ерошкин, врач-невролог неврологического отделения

125284, Москва, 2-й Боткинский пр-д, д. 5

Kirill E. Eroshkin, Neurologist, Neurology Department

5 2nd Botkinskiy Dr., Moscow 125284

erosh.kir@gmail.comhttps://orcid.org/0000-0002-2117-5016АраблинскийА. В.ArablinskyA. V.

д-р мед. наук, заведующий отделением рентгенохирургических методов диагностики и лечения

125284, Москва, 2-й Боткинский пр-д, д. 5

Alexander V. Arablinsky, Dr. Sci. (Med.), Head of Department of Roentgen-Surgical Diagnostics and Management

5 2nd Botkinskiy Dr., Moscow 125284

alexar-card@mail.ruhttps://orcid.org/0000-0001-5699-3695БагателияЗ. А.BagateliaZ. A.

Зураб Антонович Багателия, проф., д-р мед. наук, первый заместитель директора

125284, Москва, 2-й Боткинский пр-д, д. 5

Zurab A. Bagatelia, Prof., Dr. Sci. (Med.), 1st Deputy Director

5 2nd Botkinskiy Dr., Moscow 125284

bagateliaz@mail.ruГБУЗ ММНКЦ им. С.П. Боткина ДЗМРоссияMoscow Multidisciplinary Scientific and Clinical Center n.a. S.P. BotkinRussian Federation2026160320261816779Copyright © Комарова А.Г., Шаваров А.А., Закурдаев Е.И., Ерошкин К.Е., Араблинский А.В., Багателия З.А., 20262026Комарова А.Г., Шаваров А.А., Закурдаев Е.И., Ерошкин К.Е., Араблинский А.В., Багателия З.А.Komarova A.G., Shavarov A.A., Zakurdaev E.I., Eroshkin K.E., Arablinsky A.V., Bagatelia Z.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/1078Актуальность

Актуальность. Несмотря на комплексное диагностическое обследование, в 23–40% случаев причина ишемического инсульта (ИИ) остается нераспознанной. Внедрение эндоваскулярной тромбэктомии открыло возможность морфологического анализа тромботических масс.

Цель

Цель. Сравнить гистологическое строение тромбов у пациентов с разными подтипами острого ИИ.

Материал и методы

Материал и методы. Для анализа при выполнении аспирационной тромбэктомии тромботические массы были извлечены у 107 пациентов с ИИ. Оценивались связи с клиническими и операционными параметрами.

Результаты

Результаты. Содержание эритроцитов, фибрина, детрита и лейкоцитов в извлеченных тромбах было сопоставимым у пациентов с разными подтипами ИИ. У пациентов с кардиоэмболическим ИИ и ИИ неустановленной этиологии количество плазмоцитов в тромбе было статистически значимо больше, чем у лиц с атеротромботическим ИИ (10 (6;13) против 6 (4;9) клеток, p=0,020; 10 (5;18) против 6 (4;9) клеток, p=0,035 соответственно).

Выводы

Выводы. Количественная оценка состава тромбов может применяться у пациентов в дифференциальной диагностике кардиоэмболического и атеротромботического ИИ. Большая часть ИИ неуточненной этиологии имеет кардиоэмболическое происхождение.

Background

Background. Despite a complex diagnostic evaluation, the cause of ischemic stroke (IS) remains unidentified in 23-40% of cases. The implementation of endovascular thrombectomy has created the opportunities for morphological analysis of thrombotic masses.

Objective

Objective. To compare the histological structure of thrombi in patients (pts) with different subtypes of acute IS.

Material and methods

Material and methods. For analysis, thrombotic masses were extracted from 107 pts with IS during aspiration thrombectomy. The relationships with clinical and procedural parameters were assessed.

Results

Results. Fractions of erythrocytes, fibrin, detritus and leukocytes in the extracted thrombi were comparable in patients with different subtypes of IS. In pts with cardioembolic IS and IS of undetermined etiology, the plasma cell count in thrombi was statistically significantly higher than in pts with atherothrombotic IS (10 (6;13) vs. 6 (4;9) number of cells, p=0.020; 10 (5;18) vs. 6 (4;9) number of cells, p=0.035, respectively).

Conclusions

Conclusions. Quantitative examination of clot content may be used to distinguish between different IS subtypes. We suppose on the notion that the majority of IS of undetermined etiology was associated with cardioembolic source.

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The authors declare that there are no conflicts of interest present.