Background

Endovascular thrombectomy (EVT) is a treatment option in patients with a cerebral venous thrombosis (CVT) who deteriorate despite anticoagulant treatment. Assessment of thrombus composition in CVT may provide insights into the pathophysiology of the disease and suggest new therapeutic strategies.

Case report

A 47-year-old woman (smoking habit and estradiol/progesterone-releasing intra-uterine device) diagnosed with massive CVT underwent EVT (complete recanalization via aspiration catheter and stentriever) due to acute-onset left-sided weakness and dysarthria despite 72 h of full-dose subcutaneous low-molecular heparin. Two main reddish clots (maximum diameter 15 mm) were retrieved. Microscopic assessment showed an erythrocyte-rich thrombus (83.9% of entire thrombus surface) with layers of platelets/fibrin (lines of Zahn: 13.9% fibrin and 38.5% platelet [CD61+]). The immunological profile was dominated by neutrophils (30% MPO+), with neutrophil extracellular traps (NETs) in 1.9% of thrombus surface. T- (CD3+), B-lymphocytes (CD20+), and monocytes/macrophages (CD68+) were rather rare (2.2%, 0.7%, and 2.0% respectively). We found no evidence (0.0%) of hemosiderin and endothelial cells (CD34+). Full clinical recovery occurred prior to discharge.

Conclusion

This is the first case report of a CVT with histologic assessment of the thrombus retrieved via EVT. Evaluating thrombi in CVT can provide key insights into disease pathophysiology and guide treatment advancements.

中文翻译：

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探索脑静脉血栓形成中的血栓成分：第一份病例报告，提供初步见解和对治疗进展的影响

背景

血管内血栓切除术 (EVT) 是脑静脉血栓形成 (CVT) 患者的一种治疗选择，这些患者尽管接受抗凝治疗，但病情仍然恶化。对 CVT 中血栓成分的评估可以深入了解该疾病的病理生理学并提出新的治疗策略。

案例报告

一名 47 岁女性（有吸烟习惯并使用释放雌二醇/黄体酮的宫内节育器）被诊断患有大量 CVT，尽管 72 小时后仍因急性发作的左侧肌无力和构音障碍而接受 EVT（通过抽吸导管和支架完全再通）全剂量皮下注射低分子肝素。取出两个主要的红色凝块（最大直径 15 毫米）。显微镜评估显示富含红细胞的血栓（占整个血栓表面的 83.9%）和血小板/纤维蛋白层（Zahn 线：13.9% 纤维蛋白和 38.5% 血小板 [CD61+]）。免疫学特征以中性粒细胞（30% MPO+）为主，其中中性粒细胞胞外陷阱（NET）占血栓表面的 1.9%。T- (CD3+)、B-淋巴细胞 (CD20+) 和单核细胞/巨噬细胞 (CD68+) 相当罕见（分别为 2.2%、0.7% 和 2.0%）。我们没有发现含铁血黄素和内皮细胞 (CD34+) 的证据 (0.0%)。出院前已完全临床康复。

结论

这是第一份对通过 EVT 回收的血栓进行组织学评估的 CVT 病例报告。评估 CVT 中的血栓可以提供对疾病病理生理学的重要见解并指导治疗进展。