Гистологический анализ тромбов в дифференциальной диагностике подтипов ишемического инсульта

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

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

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