Stroke, Vol 22, 1276-1283, Copyright © 1991 by American Heart Association
GJ del Zoppo, GW Schmid-Schonbein, E Mori, BR Copeland and CM Chang
BACKGROUND AND PURPOSE: Microvascular perfusion defects may accompany
sustained occlusion and subsequent reperfusion of the middle cerebral
artery; however, the nature of such "no-reflow" defects remains unclear.
METHODS: In the absence of antithrombotic pretreatment, we documented
lenticulostriatal microvascular flow integrity following 3- hour middle
cerebral artery occlusion and 1-hour reperfusion in a baboon
occlusion/reperfusion model by two methods identifying 1) microvascular
occlusion and 2) microvascular patency. RESULTS: Microvascular "no-reflow"
involved capillaries (vessels of 4.0-7.5 microns diameter) of the
lenticulostriatal territory. Capillary reflow included 27-39% of all
capaillaries in two subjects, indicating a significant reduction of
perfusion from normal (2p = 0.045). In identical experimental preparations,
single polymorphonuclear leukocytes completely occluded 4.7% of
microvessels of capillary diameter in randomly selected fields, partially
occluded 3.5% of postcapillary venules, and occluded 40% (four of 10) of
capillaries in linear reconstruction along a 110 microns length.
Circumferential contact between polymorphonuclear leukocytes and the
luminal endothelial cell membranes was documented, with an intrecellular
gap of, at most, 160 nm. Fibrin was found with degranulated platelets when
the latter were associated with granulocytes, but not with
polymorphonuclear leukocytes alone. CONCLUSIONS: The finding of
capillary-obstructing polymorphonuclear leukocytes in the microvascular bed
following middle cerebral artery reperfusion in focal ischemia in this
model satisfies an essential requirement for postulating their role in
early microvascular injury and the "no-reflow" phenomenon.
ARTICLES
Polymorphonuclear leukocytes occlude capillaries following middle cerebral artery occlusion and reperfusion in baboons
Department of Molecular and Experimental Medicine, Scripps Clinic and Research Foundation, La Jolla, Calif 92037.
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