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Takahashi EA, Reisenauer CJ, Stockland AH, Bjarnason H, Neisen MJ, Neidert NB, Harmsen WS, Day CN, Misra S. Pulmonary embolism attenuation is a potential imaging biomarker for pulmonary artery hemodynamic improvement after catheter-directed thrombolysis. Vasc Med 2018; 23:134-138. [PMID: 29498612 DOI: 10.1177/1358863x18756504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study examined the potential correlation between pulmonary embolism (PE) attenuation on computed tomography pulmonary angiography (CTPA) and pulmonary artery hemodynamic response to catheter-directed thrombolysis (CDT) in 10 patients with submassive PE. Treatment parameters, PE attenuation, clot burden, computed tomography signs of right ventricle dysfunction and right ventricular systolic pressure at echocardiography were retrospectively analyzed to determine correlation with pulmonary artery pressure improvement using Spearman correlation. A single reader, blinded to the treatment results, measured PE attenuation of all patients. There was a significant positive correlation between PE attenuation and absolute pulmonary artery pressure improvement with a Spearman correlation of 0.741, p=0.014. When attenuation was greater than or equal to the median (44.5 HU, n=5), CDT was associated with significantly better pulmonary artery pressure improvement ( p=0.037). Clot attenuation at CTPA may be a potential imaging biomarker for predicting pulmonary artery pressure improvement after CDT.
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Affiliation(s)
| | - Christopher J Reisenauer
- 1 Department of Radiology, Mayo Clinic, Rochester, MN, USA.,2 Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Andrew H Stockland
- 1 Department of Radiology, Mayo Clinic, Rochester, MN, USA.,2 Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Haraldur Bjarnason
- 1 Department of Radiology, Mayo Clinic, Rochester, MN, USA.,2 Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Melissa J Neisen
- 1 Department of Radiology, Mayo Clinic, Rochester, MN, USA.,2 Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Newton B Neidert
- 1 Department of Radiology, Mayo Clinic, Rochester, MN, USA.,2 Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - William S Harmsen
- 1 Department of Radiology, Mayo Clinic, Rochester, MN, USA.,3 Department of Clinical Statistics, Mayo Clinic, Rochester, MN, USA
| | - Courtney N Day
- 3 Department of Clinical Statistics, Mayo Clinic, Rochester, MN, USA
| | - Sanjay Misra
- 1 Department of Radiology, Mayo Clinic, Rochester, MN, USA.,2 Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
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Tasci TO, Disharoon D, Schoeman RM, Rana K, Herson PS, Marr DWM, Neeves KB. Enhanced Fibrinolysis with Magnetically Powered Colloidal Microwheels. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2017; 13:10.1002/smll.201700954. [PMID: 28719063 PMCID: PMC7927958 DOI: 10.1002/smll.201700954] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/16/2017] [Indexed: 05/19/2023]
Abstract
Thrombi that occlude blood vessels can be resolved with fibrinolytic agents that degrade fibrin, the polymer that forms between and around platelets to provide mechanical stability. Fibrinolysis rates however are often constrained by transport-limited delivery to and penetration of fibrinolytics into the thrombus. Here, these limitations are overcome with colloidal microwheel (µwheel) assemblies functionalized with the fibrinolytic tissue-type plasminogen activator (tPA) that assemble, rotate, translate, and eventually disassemble via applied magnetic fields. These microwheels lead to rapid fibrinolysis by delivering a high local concentration of tPA to induce surface lysis and, by taking advantage of corkscrew motion, mechanically penetrating into fibrin gels and platelet-rich thrombi to initiate bulk degradation. Fibrinolysis of plasma-derived fibrin gels by tPA-microwheels is fivefold faster than with 1 µg mL-1 tPA. µWheels following corkscrew trajectories can also penetrate through 100 µm sized platelet-rich thrombi formed in a microfluidic model of hemostasis in ≈5 min. This unique combination of surface and bulk dissolution mechanisms with mechanical action yields a targeted fibrinolysis strategy that could be significantly faster than approaches relying on diffusion alone, making it well-suited for occlusions in small or penetrating vessels not accessible to catheter-based removal.
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Affiliation(s)
- Tonguc O Tasci
- Chemical and Biological Engineering Department, Colorado School of Mines, 1500 Illinois St., Golden, CO, 80401, USA
| | - Dante Disharoon
- Chemical and Biological Engineering Department, Colorado School of Mines, 1500 Illinois St., Golden, CO, 80401, USA
| | - Rogier M Schoeman
- Chemical and Biological Engineering Department, Colorado School of Mines, 1500 Illinois St., Golden, CO, 80401, USA
| | - Kuldeepsinh Rana
- Chemical and Biological Engineering Department, Colorado School of Mines, 1500 Illinois St., Golden, CO, 80401, USA
| | - Paco S Herson
- Department of Anesthesiology, University of Colorado School of Medicine, 12800 East 19th Ave., Aurora, CO, 80045, USA
- Department of Pharmacology, University of Colorado School of Medicine, 12800 East 19th Ave., Aurora, CO, 80045, USA
| | - David W M Marr
- Chemical and Biological Engineering Department, Colorado School of Mines, 1500 Illinois St., Golden, CO, 80401, USA
| | - Keith B Neeves
- Chemical and Biological Engineering Department, Colorado School of Mines, 1500 Illinois St., Golden, CO, 80401, USA
- Department of Pediatrics, University of Colorado School of Medicine, 12800 East 19th Ave., Aurora, CO, 80045, USA
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Vidmar J, Serša I, Kralj E, Popovič P. Unsuccessful percutaneous mechanical thrombectomy in fibrin-rich high-risk pulmonary thromboembolism. Thromb J 2015; 13:30. [PMID: 26379477 PMCID: PMC4571107 DOI: 10.1186/s12959-015-0060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/09/2015] [Indexed: 12/02/2022] Open
Abstract
Background We report a case of unsuccessful percutaneous mechanical thrombectomy in treatment of a high-risk pulmonary embolism (PE). Pulmonary thromboemboli are commonly expected as a homogenous mass, rich with red blood cell content, which respond well to percutaneous mechanical thrombectomy (PMT). Catheter-based approach or surgical embolectomy are two treatment options that are usually considered for treatment of high-risk PE when the thrombolytic therapy fails or it is contraindicated due to a patient’s persisting hemodynamic compromise. Currently, selection criteria for PE treatment options are based mostly on the assessment of patient’s history. The aim of this report is to highlight a possible treatment complication in PMT of structurally heterogeneous thrombotic mass due to PMT inadequacy. Case presentation A 32 year-old male with polytrauma was admitted to an intensive care unit after a right-sided nephrectomy and evacuation of retroperitoneal hematoma. The patient initial haemostatic disorder was improved by administration of blood preparations, an anti-fibrinolytic agent and concentrates of fibrinogen. On the third day he presented sudden onset of hemodynamic instability and was incapable of standard CTA diagnostic procedure. Urgent and relevant investigations including transthoracic and transesophageal echocardiogram confirmed a high-risk PE. PMT was performed due to contraindications for systemic thrombolysis. Long-term PMT was attempted using aspiration with several devices. No major improvement was achieved in any of the treatments and the patient died. Autopsy confirmed a large heterogeneous thrombotic mass in the pulmonary trunk folding to the right main artery. Additional histological analysis revealed a high fibrin-rich content in the peripheral surroundings of the thrombus. Conclusion In the case, it was confirmed that the outcome of PMT was directly influenced by mechanical and histological features of the thromboembolus in high-risk PE. Formation of a rather complex thromboembolus in high-risk PE favors surgical embolectomy as the only life-saving treatment option. Current diagnostic imaging techniques do not enable precise assessment of thrombi structure and are therefore unable to identify patients who might benefit from PMT or open surgical embolectomy. Surgical backup treatment should be considered if there are no contraindications in the event of a failed catheter intervention.
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Affiliation(s)
- Jernej Vidmar
- Institute of Physiology, Medical Faculty, University of Ljubljana, Zaloska cesta 4, 1000 Ljubljana, Slovenia ; Jožef Stefan Institute, Ljubljana, Slovenia
| | - Igor Serša
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Eduard Kralj
- Institute of Forensic Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Popovič
- Institue of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Evaluation of thrombolysis by using ultrasonic imaging: an in vitro study. Sci Rep 2015; 5:11669. [PMID: 26126487 PMCID: PMC4486939 DOI: 10.1038/srep11669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/01/2015] [Indexed: 12/31/2022] Open
Abstract
The hematocrit of a thrombus is a key factor associated with the susceptibility to thrombolysis. Ultrasonic imaging is currently the first-line screening tool for thrombus examinations. Different hematocrits result in different acoustical structures of thrombi, which alter the behavior of ultrasonic backscattering. This study explored the relationships among thrombolytic efficiencies, hematocrits, and ultrasonic parameters (the echo intensity and backscattered statistics). Porcine thrombi with different hematocrits, ranging from 0% to 50%, were induced in vitro. An ultrasonic scanner was used to scan thrombi and acquire raw image data for B-mode (echo intensity measurements) and Nakagami imaging (backscattered statistics analysis). Experiments on thrombolysis were performed using urokinase to explore the effect of the hematocrit on thrombolytic efficiency. Results showed that the weight loss ratio of thrombi exponentially decreased as the hematocrit increased from 0% to 50%. Compared with the echo intensity obtained from the conventional B-scan, the Nakagami parameter predicts the weight loss ratio, increasing from 0.6 to 1.2 as the weight loss ratio decreased from 0.67 to 0.26. The current findings suggest that using Nakagami imaging characterizing thrombi provides information of backscattered statistics, which may be associated with the thrombolytic efficiency.
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Vidmar J, Kralj E, Bajd F, Serša I. Multiparametric MRI in characterizing venous thrombi and pulmonary thromboemboli acquired from patients with pulmonary embolism. J Magn Reson Imaging 2014; 42:354-61. [DOI: 10.1002/jmri.24816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/12/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jernej Vidmar
- Institute of Physiology; Medical Faculty, University of Ljubljana; Slovenia
- Jožef Stefan Institute; Ljubljana Slovenia
| | - Eduard Kralj
- Institute of Forensic Medicine; Medical Faculty, University of Ljubljana; Slovenia
| | - Franci Bajd
- Jožef Stefan Institute; Ljubljana Slovenia
- Faculty of Mathematics and Physics; University of Ljubljana; Slovenia
| | - Igor Serša
- Jožef Stefan Institute; Ljubljana Slovenia
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