Assessing Composition of Coronary Thrombus in STEMI Patients - A Multiscale Approach to Charaterize Samples Obtained by Catheter Aspiration

Francesco Tessarolo, Emiliana Bonomi, Federico Piccoli, Fabiola Morat, Marta Rigoni, Iole Caola, Mattia Barbareschi, Patrizio Caciagli, Simone Muraglia, Roberto Bonmassari, Giandomenico Nollo

2014

Abstract

Percutaneous catheter thrombectomy allows collecting coronary thrombi from patients with ST-segment elevation myocardial infarction, preserving most of the sample characteristics available for both visual assessment and compositional analysis. This study aimed at identifying the association between thrombus macroscopic aspect and composition and, secondly, correlations between composition and ischemic time. Aspirated thrombi were grouped into “white”, “red” or “mixed” according to their macroscopic appearance. Platelets, RBCs and fibrin were quantified on thrombus surface by SEM and on thrombus sections by a modified Carstairs histochemical staining. Fifty-three samples from 51 patients were included. The median [inter-quartile range] ischemic time was 210 [190-265] min. Seven (13%) “white”, 19(36%) “mixed” and 27(51%) “red” thrombi were macroscopically identified. Median thrombus composition assessed by SEM was 23[11-41]%, 43[26-62]%, and 24[11-37]% for platelets, RBCs and fibrin respectively. Median histological analysis was 10[5-26]%, 45[31-64]% and 30[18-49]% for the same components. Significant difference in composition were found between “white” and “red” thrombi, showing respectively a higher amount of platelets (p=0.003) and fibrin (p=0.007). No significant correlations were found between composition and ischemic time suggesting that plaque instability and thrombus formation can occur before the symptom onset.

References

  1. Altman, DG., 1991. Practical statistics for medical research. Chapman & Hall/CRC.
  2. Burzotta, F., De Vita, M., Gu, YL., et al., 2009. Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. Eur. Heart. J. 30 (18):2193-2203.
  3. Carstairs, KC., 1965. The identification of platelet antigens in histological sections. J. Path. bact. 90 (1): 225-31.
  4. De Luca, G., Dudek, D., Sardella, G., et al., 2008. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur. Heart. J. 29(24):3002-3010.
  5. Keeley, EC., Boura, JA., Grines, CL. 2003. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet 361: 13-20.
  6. Kirchhof, K., Welzel, T., Mecke, c., et al., 2003. Differentiation of white, mixed and red thrombi: value of CT in estimation of the prognosis of thrombolysisphantom study. Radiology 228:126-130.
  7. Kramer, MC., Allard, C., Van der Wal, AC., et al., 2008. Presence of older thrombus is an independent predictor of long term mortality in patients with STelevation myocardial infarction treated with thrombus aspiration during primary percutaneous coronary intervention. Circulation 118:1810-1816.
  8. Kramer, MC., Van der Wal, AC., Koch, KT., et al., 2009. Histopatological features of aspirated thrombi after percutaneous coronary intervention in patients with ST-elevation myocardial infarction. PLoS One 4:e 5817.
  9. Lucas, TC., Tessarolo, F., Veniero, P., et al., 2013. Hemodialysis catheter thrombi: visualization and quantification of microstructures and cellular composition. J. Vasc. Access 14(3):257-263.
  10. Lucas, TC., Tessarolo, F., Veniero, P., et al., 2014. Quantification of fibrin in blood thrombi formed in hemodialysis central venous catheters: a pilot study on 43 CVCs. J. Vasc. Access Jan 21 Epub ahead of print doi: 10.5301/jva.5000200.
  11. Quadros, SA., Cambruzzi, E., Sebben J., et al. 2012. Red versus white thrombi in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: clinical and angiographic outcomes. Am. Heart J. 164:553-560.
  12. Rittersma, SZ., Van der Wal, AC., Koch, KT., et al., 2005. Plaque instability frequently occurs days or weeks before occlusive coronary thrombosis: a pathological thrombectomy study in primary percutaneous coronary intervention. Circulation 111 (9):1160-1165.
  13. Silvain, J., Collet, JP., Nagaswami, C, et al., 2011. Composition of coronary thrombus in acute myocardial infarction. J. Am. Coll. Cardiol. 57 (12):1359-1367.
  14. Steg, PG., James, SK., Atar, D., et al, 2012. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart. J. 33(20):2569-2619.
  15. Uchida, Y., Uchida, Y., Sakurai, T., et al., 2011. Syndrome Using Dye-Staining Angioscopy Characterization of Coronary Fibrin Thrombus in Patients With Acute Coronary. Arterioscler. Thromb. Vasc. Biol. 31:1452-1460.
  16. Van de Werf, F., Bax, J., Betriu, A., et al., 2008. ESC Committee for practice guidelines. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation. Eur. Heart J. 29: 2909-2945.
  17. Vlaar, PJ., Svilaas, T., van der Horst, IC., et al., 2008. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet 371(9628):1915-20.
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Paper Citation


in Harvard Style

Tessarolo F., Bonomi E., Piccoli F., Morat F., Rigoni M., Caola I., Barbareschi M., Caciagli P., Muraglia S., Bonmassari R. and Nollo G. (2014). Assessing Composition of Coronary Thrombus in STEMI Patients - A Multiscale Approach to Charaterize Samples Obtained by Catheter Aspiration . In Proceedings of the 2nd International Congress on Cardiovascular Technologies - Volume 1: CARDIOTECHNIX, ISBN 978-989-758-055-0, pages 5-12. DOI: 10.5220/0005144600050012


in Bibtex Style

@conference{cardiotechnix14,
author={Francesco Tessarolo and Emiliana Bonomi and Federico Piccoli and Fabiola Morat and Marta Rigoni and Iole Caola and Mattia Barbareschi and Patrizio Caciagli and Simone Muraglia and Roberto Bonmassari and Giandomenico Nollo},
title={Assessing Composition of Coronary Thrombus in STEMI Patients - A Multiscale Approach to Charaterize Samples Obtained by Catheter Aspiration},
booktitle={Proceedings of the 2nd International Congress on Cardiovascular Technologies - Volume 1: CARDIOTECHNIX,},
year={2014},
pages={5-12},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0005144600050012},
isbn={978-989-758-055-0},
}


in EndNote Style

TY - CONF
JO - Proceedings of the 2nd International Congress on Cardiovascular Technologies - Volume 1: CARDIOTECHNIX,
TI - Assessing Composition of Coronary Thrombus in STEMI Patients - A Multiscale Approach to Charaterize Samples Obtained by Catheter Aspiration
SN - 978-989-758-055-0
AU - Tessarolo F.
AU - Bonomi E.
AU - Piccoli F.
AU - Morat F.
AU - Rigoni M.
AU - Caola I.
AU - Barbareschi M.
AU - Caciagli P.
AU - Muraglia S.
AU - Bonmassari R.
AU - Nollo G.
PY - 2014
SP - 5
EP - 12
DO - 10.5220/0005144600050012