1
|
Abramowitz SD, Kado H, Schor J, Annambhotla S, Mojibian H, Marino AG, Maldonado TS, Gandhi S, Paulisin J, Bunte MC, Angel W, Roberts J, Veerina K, Long D, Elmasri F, Shaikh A, Beasley RE, Dexter D. Six-Month Deep Vein Thrombosis Outcomes by Chronicity: Analysis of the Real-World ClotTriever Outcomes Registry. J Vasc Interv Radiol 2023; 34:879-887.e4. [PMID: 37105663 DOI: 10.1016/j.jvir.2022.12.480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To analyze the first 250 patients from the prospective, multicenter, industry-sponsored ClotTriever Outcomes (CLOUT) registry, assessing the safety and effectiveness of mechanical thrombectomy for acute, subacute, and chronic deep vein thrombosis (DVT). MATERIALS AND METHODS Real-world patients with lower extremity DVT were treated with the ClotTriever System (Inari Medical, Irvine, California). Adjuvant venoplasty, stent placement, or both were performed at the physician's discretion. Thrombus chronicity was determined by visual inspection of removed thrombus, categorizing patients into acute, subacute, and chronic subgroups. Serious adverse events (SAEs) were assessed through 30 days. Clinical and quality-of-life (QoL) outcomes are reported through 6 months. RESULTS Thrombus chronicity was designated for 244 of the 250 patients (acute, 32.8%; subacute, 34.8%; chronic, 32.4%) encompassing 254 treated limbs. Complete or near-complete (≥75%) thrombus removal was achieved in 90.8%, 81.9%, and 83.8% of the limbs with acute, subacute, and chronic thrombus, respectively. No fibrinolytics were administered, and 243 (99.6%) procedures were single sessions. One (0.4%) patient in the subacute group experienced a device-related SAE, a fatal pulmonary embolism. On comparing baseline and 6-month data, improvements were demonstrated in median Villalta scores (acute, from 10 to 1; subacute, from 9 to 1; chronic, from 10 to 3; for all, P < .0001) and mean EuroQol group 5-dimension (EQ-5D) self-report questionnaire scores (acute, 0.58 to 0.89; subacute, 0.65 to 0.87; chronic, 0.58 to 0.88; for all, P < .0001). There were no significant differences in outcomes across the subgroups. CONCLUSIONS Mechanical thrombectomy using the ClotTriever System with adjunctive venoplasty and stent placement is safe and similarly effective for acute, subacute, and chronic DVT.
Collapse
Affiliation(s)
| | - Herman Kado
- Ascension Providence Hospital, Farmington Hills, Michigan; William Beaumont Hospital, Royal Oak, Michigan
| | | | | | | | | | | | - Sagar Gandhi
- Prisma Health Upstate, Greenville, South Carolina
| | | | - Matthew C Bunte
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Wesley Angel
- Methodist Healthcare Foundation, Germantown, Tennessee
| | - Jon Roberts
- Methodist Healthcare Foundation, Germantown, Tennessee
| | | | | | | | - Abdullah Shaikh
- Allegheny Health Network Research Institute, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|
8
|
Andia ME, Saha P, Jenkins J, Modarai B, Wiethoff AJ, Phinikaridou A, Grover SP, Patel AS, Schaeffter T, Smith A, Botnar RM. Fibrin-targeted magnetic resonance imaging allows in vivo quantification of thrombus fibrin content and identifies thrombi amenable for thrombolysis. Arterioscler Thromb Vasc Biol 2014; 34:1193-1198. [PMID: 24723557 DOI: 10.1161/atvbaha.113.302931] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Deep venous thrombosis is a major health problem. Thrombolytic therapies are effective in recanalizing the veins and preventing post-thrombotic complications, but there is no consensus on selection criteria. The aim of this study was to investigate a fibrin-specific MRI contrast agent (EP-2104R) for the accurate quantification of thrombus' fibrin content in vivo and for the identification of thrombus suitable for thrombolysis. APPROACH AND RESULTS Venous thrombosis was induced in the inferior vena cava of 8- to 10-week-old male BALB/C mice and MRI performed 2, 4, 7, 10, 14, and 21 days later. Eighteen mice were scanned at each time point pre and 2 hours post injection of EP-2104R (8.0 μmol/kg) with 12 mice at each time point used to correlate fibrin contrast uptake with thrombus' histological stage and fibrin content. Six mice at each time point were immediately subjected to intravascular thrombolytic therapy (10 mg/kg of tissue-type plasminogen activator). Mice were imaged to assess response to lytic therapy 24 hours after thrombolytic treatment. Two mice at each time point were scanned post injection of 0.2 mmol/kg of Gd-DTPA (gadolinium with diethylenetriaminepentacetate, Magnevist, Schering AG, Berlin, Germany) for control purpose. Contrast uptake was correlated positively with the fibrin content of the thrombus measured by Western blotting (R(2)=0.889; P<0.001). Thrombus relaxation rate (R1) post contrast and the change in visualized thrombus size on late gadolinium enhancement inversion recovery MRI pre-EP-2104R and post-EP-2104R injection were the best predictors for successful thrombolysis (area under the curve, 0.989 [95% confidence interval, 0.97-1.00] and 0.994 [95% confidence interval, 0.98-1.00] respectively). CONCLUSIONS MRI with a fibrin-specific contrast agent accurately estimates thrombus fibrin content in vivo and identifies thrombi that are amenable for thrombolysis.
Collapse
Affiliation(s)
- Marcelo E Andia
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Prakash Saha
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Julia Jenkins
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Bijan Modarai
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Andrea J Wiethoff
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Alkystis Phinikaridou
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Steven P Grover
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Ashish S Patel
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Alberto Smith
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Rene M Botnar
- Division of Imaging Sciences and Biomedical Engineering, School of Medicine, St Thomas' Hospital, King's College London, London, Received on: May 3, 2013; final version accepted on: April 1, 2014. United Kingdom (M.E.A., A.J.W., A.P., T.S., R.M.B.); Academic Department of Surgery, Cardiovascular Division (P.S., J.J., B.M., S.P.G., A.S.P., A.S.), Wellcome Trust and EPSRC Medical Engineering Centre (T.S., R.M.B.), BHF Centre of Excellence, Cardiovascular Division (T.S., A.S., R.M.B.), and NIHR Biomedical Research Centre, GSTT (T.S., A.S., R.M.B.), School of Medicine, King's College London, London, United Kingdom; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| |
Collapse
|
9
|
Phinikaridou A, Andia ME, Saha P, Modarai B, Smith A, Botnar RM. In vivo magnetization transfer and diffusion-weighted magnetic resonance imaging detects thrombus composition in a mouse model of deep vein thrombosis. Circ Cardiovasc Imaging 2013; 6:433-440. [PMID: 23564561 DOI: 10.1161/circimaging.112.000077] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Deep vein thrombosis remains a major health problem necessitating accurate diagnosis. Thrombolysis is associated with significant morbidity and is effective only for the treatment of unorganized thrombus. We tested the feasibility of in vivo magnetization transfer (MT) and diffusion-weighted magnetic resonance imaging to detect thrombus organization in a murine model of deep vein thrombosis. METHODS AND RESULTS Deep vein thrombosis was induced in the inferior vena cava of male BALB/C mice. Magnetic resonance imaging was performed at days 1, 7, 14, 21, and 28 after thrombus induction using MT, diffusion-weighted, inversion-recovery, and T1-mapping protocols. Delayed enhancement and T1 mapping were repeated 2 hours after injection of a fibrin contrast agent. Finally, excised thrombi were used for histology. We found that MT and diffusion-weighted imaging can detect histological changes associated with thrombus aging. MT rate (MTR) maps and percentage of MT rate (%MTR) allowed visualization and quantification of the thrombus protein content, respectively. The %MTR increased with thrombus organization and was significantly higher at days 14, 21, and 28 after thrombus induction (days 1, 7, 14, 21, 28: %MTR=2483±451, 2079±1210, 7029±2490, 10 295±4356, 32 994±25 449; PANOVA<0.05). There was a significant positive correlation between the %MTR and the histological protein content of the thrombus (r=0.70; P<0.05). The apparent diffusion coefficient was lower in erythrocyte-rich and collagen-rich thrombus (0.72±0.10 and 0.69±0.05 [×10(-3) mm(2)/s]). Thrombus at days 7 and 14 had the highest apparent diffusion coefficient values (0.95±0.09 and 1.10±0.18 [×10(-3) mm(2)/s]). CONCLUSIONS MT and diffusion-weighted magnetic resonance imaging sequences are promising for the staging of thrombus composition and could be useful in guiding medical intervention.
Collapse
Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Marcelo E Andia
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Prakash Saha
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Bijan Modarai
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Alberto Smith
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - René M Botnar
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| |
Collapse
|