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Griffin MS, Dahlgren AR, Nagaswami C, Litvinov RI, Keeler K, Madenjian C, Fuentes R, Fish RJ, Neerman-Arbez M, Holinstat M, Adili R, Weisel JW, Shavit JA. Composition of thrombi in zebrafish: similarities and distinctions with mammals. J Thromb Haemost 2024; 22:1056-1068. [PMID: 38160724 PMCID: PMC11293624 DOI: 10.1016/j.jtha.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Blood clots are primarily composed of red blood cells (RBCs), platelets/thrombocytes, and fibrin. Despite the similarities observed between mammals and zebrafish, the composition of fish thrombi is not as well known. OBJECTIVES To analyze the formation of zebrafish blood clots ex vivo and arterial and venous thrombi in vivo. METHODS Transgenic zebrafish lines and laser-mediated endothelial injury were used to determine the relative ratio of RBCs and thrombocytes in clots. Scanning electron and confocal microscopy provided high-resolution images of the structure of adult and larval clots. Adult and larval thrombocyte spreading on fibrinogen was evaluated ex vivo. RESULTS RBCs were present in arterial and venous thrombi, making up the majority of cells in both circulations. However, bloodless mutant fish demonstrated that fibrin clots can form in vivo in the absence of blood cells. Scanning electron and confocal microscopy showed that larval and adult zebrafish thrombi and mammalian thrombi look surprisingly similar externally and internally, even though the former have nucleated RBCs and thrombocytes. Although adult thrombocytes spread on fibrinogen, we found that larval cells do not fully activate without the addition of plasma from adult fish, suggesting a developmental deficiency of a plasma activating factor. Finally, mutants lacking αIIbβ3 demonstrated that this integrin mediates thrombocyte spreading on fibrinogen. CONCLUSION Our data showed strong conservation of arterial and venous and clot/thrombus formation across species, including developmental regulation of thrombocyte function. This correlation supports the possibility that mammals also do not absolutely require circulating cells to form fibrin clots in vivo.
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Affiliation(s)
- Megan S Griffin
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna R Dahlgren
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Chandrasekaran Nagaswami
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rustem I Litvinov
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kevin Keeler
- US Geological Survey Great Lakes Science Center, Ann Arbor, Michigan, USA
| | - Charles Madenjian
- US Geological Survey Great Lakes Science Center, Ann Arbor, Michigan, USA
| | - Ricardo Fuentes
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Richard J Fish
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Michael Holinstat
- Department of Pharmacology, University of Michigan, Ann Arbor, Michigan, USA
| | - Reheman Adili
- Department of Pharmacology, University of Michigan, Ann Arbor, Michigan, USA
| | - John W Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jordan A Shavit
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA; Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA.
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Alkarithi G, Duval C, Shi Y, Macrae FL, Ariëns RAS. Thrombus Structural Composition in Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2021; 41:2370-2383. [PMID: 34261330 PMCID: PMC8384252 DOI: 10.1161/atvbaha.120.315754] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thrombosis is a major complication of cardiovascular disease, leading to myocardial infarction, acute ischemic stroke, or venous thromboembolism. Thrombosis occurs when a thrombus forms inside blood vessels disrupting blood flow. Developments in thrombectomy to remove thrombi from vessels have provided new opportunities to study thrombus composition which may help to understand mechanisms of disease and underpin improvements in treatments. We aimed to review thrombus compositions, roles of components in thrombus formation and stability, and methods to investigate thrombi. Also, we summarize studies on thrombus structure obtained from cardiovascular patients and animal models. Thrombi are composed of fibrin, red blood cells, platelets, leukocytes, and neutrophil extracellular traps. These components have been analyzed by several techniques, including scanning electron microscopy, laser scanning confocal microscopy, histochemistry, and immunohistochemistry; however, each technique has advantages and limitations. Thrombi are heterogenous in composition, but overall, thrombi obtained from myocardial infarction are composed of mainly fibrin and other components, including platelets, red blood cells, leukocytes, and cholesterol crystals. Thrombi from patients with acute ischemic stroke are characterized by red blood cell- and platelet-rich regions. Thrombi from patients with venous thromboembolism contain mainly red blood cells and fibrin with some platelets and leukocytes. Thrombus composition from patients with myocardial infarction is influenced by ischemic time. Animal thrombosis models are crucial to gain further mechanistic information about thrombosis and thrombus structure, with thrombi being similar in composition compared with those from patients. Further studies on thrombus composition and function are key to improve treatment and clinical outcome of thrombosis.
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Affiliation(s)
- Ghadir Alkarithi
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.).,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia (G.A.)
| | - Cédric Duval
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Yu Shi
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Fraser L Macrae
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Robert A S Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
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Yang X, Leesar MA, Ahmed H, Lendel V, Rodriguez G, Mutlu D, Cawich I, Prasad A, Oglesby M, Marmagkiolis K, Phillips NE, Jouke D, Michalek J, Liu Q, Milner T, McElroy A, Hoyt T, Feldman MD, Cilingiroglu M. Impact of ticagrelor and aspirin versus clopidogrel and aspirin in symptomatic patients with peripheral arterial disease: Thrombus burden assessed by optical coherence tomography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:778-784. [DOI: 10.1016/j.carrev.2018.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Accepted: 02/21/2018] [Indexed: 11/17/2022]
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4
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Yang Y, Li J, Xu W, Dong S, Yu H, Song H, Chu Y. Thrombus aspirated from patients with ST-elevation myocardial infarction: Clinical and angiographic outcomes. J Int Med Res 2016; 44:1514-1523. [PMID: 27834302 PMCID: PMC5536757 DOI: 10.1177/0300060516667373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To investigate differences in clinical and angiographic outcomes between patients with acute myocardial infarction with red and white thrombi. Methods A total of 137 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary interventions were included. Thrombus material was classified as white or red based on its pathology. Information on characteristics of thrombi was available for 97 (70.8%) patients. Results The total ischaemic time was significantly longer in the red thrombus group compared with the white thrombus group. The incidence of major adverse cardiovascular events in hospital was higher in the red thrombus group than in the white thrombus group (15.6% vs 0%). Multivariable logistic analysis showed that the total ischaemic time was the only predictor of thrombus composition (odds ratio 1.353; 95% confidence interval 1.003, 1.826). Conclusion Red thrombi were present in nearly two-thirds of cases, and were associated with a longer ischaemic time and higher incidence of major adverse cardiovascular events in hospital.
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Affiliation(s)
- Yapan Yang
- 1 Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jingchao Li
- 1 Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Wenke Xu
- 2 Department of Emergency Center, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Shujuan Dong
- 1 Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Haijia Yu
- 2 Department of Emergency Center, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Huihui Song
- 2 Department of Emergency Center, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yingjie Chu
- 1 Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
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5
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Kočka V, Toušek P. Manual aspiration thrombectomy devices use in coronary interventions in 2016. Expert Rev Med Devices 2016; 13:243-51. [PMID: 26808609 DOI: 10.1586/17434440.2016.1146586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Percutaneous coronary intervention is a highly effective therapy of acute myocardial infarction. Restoration of microcirculation is however often sub-optimal with negative impact on patient outcome. Distal thrombus embolization may contribute to this issue. Simple manual aspiration thrombectomy catheters were developed with aim of thrombus extraction. There are several of these devices with very similar design. Thrombotic or atheromatous tissue is successfully retrieved in over 70% of patients. The initial results of small, often single center studies have provided encouraging results. Unfortunately, three further studies clearly demonstrated lack of any clinical benefit and routine use of manual aspiration thrombectomy cannot be recommended. Small but statistically significant increase in stroke rate is the major safety issue. Selective use in patients with large thrombus burden or suboptimal flow or perfusion is likely to continue and needs to be scientifically studied.
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Affiliation(s)
- Viktor Kočka
- a Cardiocentre, Third Medical Faculty , Charles University in Prague , Prague 10 , Czech Republic
| | - Petr Toušek
- a Cardiocentre, Third Medical Faculty , Charles University in Prague , Prague 10 , Czech Republic
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6
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Red versus white thrombi in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: clinical and angiographic outcomes. Am Heart J 2012; 164:553-60. [PMID: 23067914 DOI: 10.1016/j.ahj.2012.07.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 07/24/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Aspiration thrombectomy is used in primary percutaneous coronary interventions, but the importance of thrombus constituency has been scarcely investigated. The objective of this study was to evaluate thrombus constituency and its association with clinical, laboratory, and angiographic findings in patients with ST-segment elevation myocardial infarction. METHODS From April 2010 to May 2011, 562 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary interventions were considered for inclusion, and information on thrombi characteristics was available for 113 patients. Thrombus material were obtained and classified as white or red based on its constituency. Samples were analyzed by 3 independent pathologists blinded to clinical characteristics. RESULTS The mean age of patients was 58.6 ± 12.7 years, and 69% were men. White thrombi were present in 31% of cases, and red thrombi, in 69%. Patients with white thrombi had smaller vessels and lower ischemic times. All other clinical, angiographic, and laboratory characteristics did not differ. White thrombi were smaller and associated with fibrin infiltration, whereas red thrombi were associated with red blood cell infiltration. Thirty-day death rates were lower in patients with white thrombi than red (0% vs 10.1%, respectively; P = .05), as were 30-day major adverse cardiac event rates (4.2% vs 13.9%; P = .10). Total ischemic time was well correlated with fibrin infiltration (R = -0.30; P < .01), red blood cell infiltration (R = 0.27; P < .01), and thrombus volume (R = 0.22; P = .02). CONCLUSIONS White thrombi were present in one-third of cases and were associated with lower ischemic times, higher fibrin infiltration, smaller thrombus volume, and lower mortality. These findings suggest that thrombus constituency may be a useful prognostic tool in this setting.
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Srikanth S, Ambrose JA. Pathophysiology of coronary thrombus formation and adverse consequences of thrombus during PCI. Curr Cardiol Rev 2012; 8:168-76. [PMID: 22920487 PMCID: PMC3465820 DOI: 10.2174/157340312803217247] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 03/17/2012] [Accepted: 04/12/2012] [Indexed: 02/08/2023] Open
Abstract
Atherosclerosis is a systemic vascular pathology that is preceded by endothelial dysfunction. Vascular inflammation "fuels" atherosclerosis and creates the milieu for episodes of intravascular thromboses. Thrombotic events in the coronary vasculature may lead to asymptomatic progression of atherosclerosis or could manifest as acute coronary syndromes or even sudden cardiac death. Thrombus encountered in the setting of acute coronary syndromes has been correlated with acute complications during percutaneous coronary interventions such as no-reflow, acute coronary occlusion and long term complications such as stent thrombus. This article reviews the pathophysiology of coronary thrombogenesis and explores the complications associated with thrombus during coronary interventions.
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Affiliation(s)
- Sundararajan Srikanth
- Interventional Cardiology Fellow, UCSF Fresno, University of California San Francisco Chief of Cardiology, UCSF Fresno
| | - John A Ambrose
- Professor of Medicine, University of California San Francisco Chief of Cardiology, UCSF Fresno
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Escaned J, Gonzalo N. Lessons learned from advanced intracoronary imaging in patients with acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2011; 12:868-77. [DOI: 10.2459/jcm.0b013e32834da56a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Angioscopy and Unstable Coronary Plaques: Findings Beyond Thrombus. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Regar E. Invasive imaging technologies: can we reconcile light and sound? J Cardiovasc Med (Hagerstown) 2011; 12:562-70. [PMID: 21709573 DOI: 10.2459/jcm.0b013e3283492b5a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since the introduction of intravascular, catheter-based invasive imaging and diagnostic tools in the catheterization laboratories two decades ago, the functional assessment of angiographically moderate or ambiguous lesions by fractional flow reserve measurements represents the established standard of care today. Likewise, intravascular ultrasound (IVUS) is widely accepted to guide treatment strategy in complex lesions, such as long or left main stem lesions. Developments are driven by the clinical interest to optimize treatment, prevent periprocedural complications, understand treatment failure and understand progression of atherosclerosis. As a result, a variety of devices are now clinically available that enable detection and monitoring of specific plaque features over time, such as the presence of necrotic core by IVUS-VH, a lipid-core plaque by near infrared (NIR) spectroscopy or a thin fibrous cap atheroma by optical coherence tomography (OCT). As the physical boundaries for both light and sound are different, these imaging technologies offer different advantages and limitations. Light-based technologies offer unparalleled high image resolution (OCT) or unparalleled high sensitivity and specificity for distinct plaque components (NIR spectroscopy), whereas conventional IVUS offers a much better tissue penetration. From a clinical perspective, both types of information are valuable. Ideally, this information should easily and in real time be available in the catheterization laboratory, consisting of co-registered datasets gained during a single catheter pullback. On this background, a combined NIR spectroscopy and IVUS catheter has recently been introduced for clinical use. The article discusses the potential and limitations of these different technologies. They may allow advanced coronary plaque diagnosis in a fast, accurate, reliable, user- and patient-friendly manner and, as such, can help to improve clinical practice today and therapeutic options in the future.
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Affiliation(s)
- Evelyn Regar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus, Rotterdam, The Netherlands.
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Nikus K, Pahlm O, Wagner G, Birnbaum Y, Cinca J, Clemmensen P, Eskola M, Fiol M, Goldwasser D, Gorgels A, Sclarovsky S, Stern S, Wellens H, Zareba W, de Luna AB. Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology. J Electrocardiol 2010; 43:91-103. [DOI: 10.1016/j.jelectrocard.2009.07.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Indexed: 10/20/2022]
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12
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Jaffe R, Irfan A, Hong T, Chisholm RJ, Cheema AN. Intraluminal filling defects on coronary angiography: more than meets the eye. Clin Cardiol 2007; 30:480-4. [PMID: 17803206 PMCID: PMC6653148 DOI: 10.1002/clc.20062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 11/16/2006] [Indexed: 11/08/2022] Open
Abstract
Intraluminal filling defects are occasionally encountered on coronary angiography and often related with coronary thrombi. However, other conditions affecting the coronary arteries may present with similar angiographic findings causing diagnostic uncertainty. Accurate characterization of the angiographic filling defect is critical, particularly in patients planned for a percutaneous coronary intervention (PCI), as diagnosis of a coronary thrombus not only increases the risk of post procedural adverse events but also requires a specific therapeutic approach. In this paper, we report three patients in whom coronary angiography revealed intraluminal filling defects mimicking coronary thrombi. When further investigated with intravascular ultrasound (IVUS) as a part of the planned PCI, the thrombus was excluded and alternate etiology of the filling defect was confirmed in all patients. The angiographic "pseudothrombi" were produced by coronary dissection in one and by heavy calcification within the atherosclerotic plaque in two patients. The use of IVUS allowed accurate characterization of the angiographic filling defect and provided important information to guide management and optimize therapeutic approach.
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Affiliation(s)
- Ronen Jaffe
- Terrence Donnelly Heart Center, Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Affan Irfan
- Terrence Donnelly Heart Center, Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tony Hong
- Terrence Donnelly Heart Center, Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Robert J. Chisholm
- Terrence Donnelly Heart Center, Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Asim N. Cheema
- Terrence Donnelly Heart Center, Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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Johnstone E, Friedl SE, Maheshwari A, Abela GS. Distinguishing characteristics of erythrocyte-rich and platelet-rich thrombus by intravascular ultrasound catheter system. J Thromb Thrombolysis 2007; 24:233-9. [PMID: 17396229 DOI: 10.1007/s11239-007-0027-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Accepted: 03/01/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute coronary syndromes are associated with platelet-rich, white thrombi (WT) and erythrocyte-rich, red thrombi (RT), but their ultrasonic characteristics are not well defined. To determine whether intravascular ultrasound (IVUS) could be used to detect specific characteristics of WT and RT, two experiments were performed. METHODS An in-vitro experiment evaluated five WT and five RT and an ex-vivo experiment evaluated thrombi from 17 atherosclerotic rabbits with disrupted plaques and overlying thrombi. Specimen were mounted flat, immersed in a saline bath and examined from the intimal surface. Thrombi were classified as WT (n = 69) or RT (n = 40) by gross inspection and histology. IVUS was performed using a 1 mm, 20 MHz transducer in a 4.8F catheter. Images were digitally converted and points integrated to account for angular and depth resolution. Sampling was performed at the water-tissue interface and four other sites at 0.3 mm radial depth increments. Signals from each depth were standardized by obtaining the ratio of each energy level to the level at the water-tissue interface. RESULTS The average energy ratio backscattered by RT was constant with increasing tissue depth while it attenuated for WT (P < 0.005; 2-way ANOVA). RT was less homogeneous and had more backscatter compared to WT. Light and electron microscopy corroborated these observations showing WT as densely homogenous and RT with loose cellular elements. CONCLUSION WT may be detected by its attenuated ultrasound pattern versus a non-attenuated pattern for RT by IVUS. This technique has potential for characterizing WT and RT.
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Affiliation(s)
- Eric Johnstone
- Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, MA, USA
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Ma H, Aziz KS, Huang R, Abela GS. Arterial wall cholesterol content is a predictor of development and severity of arterial thrombosis. J Thromb Thrombolysis 2006; 22:5-11. [PMID: 16786227 DOI: 10.1007/s11239-006-7861-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is unclear if total cholesterol content contributes to the severity of cardiovascular events by affecting the amount of thrombosis. This study evaluated relationships between cholesterol levels and the amount of thrombosis in an atherosclerotic rabbit model of plaque disruption and thrombosis. METHODS Three groups of NZW rabbits were used: normal rabbits (Group I, n = 4); atherosclerotic rabbits (Group II, n = 4); and atherosclerotic rabbits with pharmacologically triggered thrombosis (Group III, n = 16). Atherosclerosis was induced by feeding a cholesterol enriched diet and balloon deendothelialization. At post-mortem, platelet-rich thrombus and arterial wall cholesterol were quantified and histology performed by light and electron microscopy. RESULTS Arterial wall cholesterol was strongly correlated to serum cholesterol in all groups (r = 0.94, p < 0.0001). There was a significant correlation between the thrombus surface area with arterial wall cholesterol in Group III (r = 0.71, p < 0.002). Serum cholesterol, arterial wall cholesterol, and thrombus surface area were all significantly correlated but only arterial wall cholesterol was an independent predictor of thrombosis. A threshold specific for this model was noted for serum and arterial cholesterol levels above which thrombosis consistently occurred. CONCLUSIONS Arterial wall cholesterol was strongly correlated to serum cholesterol and thrombosis severity. Serum cholesterol, arterial wall cholesterol and thrombus surface area were all integrally related.A model of plaque disruption and thrombosis was used to demonstrate a correlation between serum and arterial wall cholesterol (r = 0.94; p < 0.0001); arterial wall cholesterol and the amount of thrombosis (surface area; r = 0.71, p < 0.002). A threshold of serum and arterial cholesterol was determined at which thrombosis occurred in this model.
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Affiliation(s)
- Hongbao Ma
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, Michigan 48824, USA
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15
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Ishibashi F, Aziz K, Abela GS, Waxman S. Update on coronary angioscopy: review of a 20-year experience and potential application for detection of vulnerable plaque. J Interv Cardiol 2006; 19:17-25. [PMID: 16483335 DOI: 10.1111/j.1540-8183.2006.00099.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Predicting the occurrence of future acute coronary syndromes remains an important challenge of contemporary cardiology. It is thought that detecting the individual vulnerable plaques in patients can be an important step to preventing myocardial infarction and sudden cardiac death. Coronary angioscopy can provide detailed information of the luminal surface of plaque, such as color, thrombus, or disruption, and is one of a few possibly useful imaging modalities for identifying vulnerable plaques. During its 20-year history, coronary angioscopy has been used as a diagnostic tool or to guide coronary angioplasty, and has contributed to our understanding of the pathophysiology of coronary artery disease. Yellow plaques seen during angioscopy seem to have many characteristics of high risk or vulnerable plaques, most consistent with the thin-cap fibroatheroma. Moreover, differences in yellow color have been reported to reflect differences in the structure or composition of plaques. Development of quantitative methods to assess plaque color and histopathologic correlations in conjunction with prospective natural history studies may lead to advances in vulnerable plaque detection by coronary angioscopy. Although current angioscopic devices are limited by the need to displace the column of blood in order to see the vessel wall, and by the lack of quantitative colorimetric methods, advances in technology may lead to new device versions that could be practical for expanded clinical use.
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Affiliation(s)
- Fumiyuki Ishibashi
- Department of Medicine, Cardiology, Lahey Clinic, Burlington, Massachusetts 01805, USA
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16
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Kim WY, Spuentrup E, Buecker A, Manning WJ, Botnar RM. Cardiovascular magnetic resonance imaging of coronary atherothrombosis. J Nucl Cardiol 2005; 12:337-44. [PMID: 15944539 DOI: 10.1016/j.nuclcard.2005.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- W Yong Kim
- MR-Center, Institute of Clinical Medicine, Aarhus University Hospital, Skejby Sygehus, Denmark.
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17
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Botnar RM, Buecker A, Wiethoff AJ, Parsons EC, Katoh M, Katsimaglis G, Weisskoff RM, Lauffer RB, Graham PB, Gunther RW, Manning WJ, Spuentrup E. In vivo magnetic resonance imaging of coronary thrombosis using a fibrin-binding molecular magnetic resonance contrast agent. Circulation 2004; 110:1463-6. [PMID: 15238457 DOI: 10.1161/01.cir.0000134960.31304.87] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The advent of fibrin-binding molecular magnetic resonance (MR) contrast agents and advances in coronary MRI techniques offers the potential for direct imaging of coronary thrombosis. We tested the feasibility of this approach using a gadolinium (Gd)-based fibrin-binding contrast agent, EP-2104R (EPIX Medical Inc), in a swine model of coronary thrombus and in-stent thrombosis. METHODS AND RESULTS Ex vivo and in vivo sensitivity of coronary MR thrombus imaging was tested by use of intracoronarily delivered Gd-DTPA-labeled fibrinogen thrombi (n=6). After successful demonstration, in-stent coronary thrombosis was induced by x-ray-guided placement of thrombogenic-coated, MR-lucent stents (n=5). After stent placement, 60 micromol of EP-2104R was injected via the left main coronary artery. Free-breathing, navigator-gated 3D coronary MR angiography and thrombus imaging were performed (1) before and after stent placement and (2) before and after EP-2104R. Thrombi were confirmed by x-ray angiography and autopsy. Fibrinogen thrombi: 5 of 6 intracoronarily delivered Gd-labeled fibrinogen clots (approximately 250 micromol/L Gd) were visible on MRI and subsequently confirmed by x-ray angiography. In-stent thrombi: in-stent thrombosis was observed in all stents after EP-2104R. Four of 5 thrombi were confirmed by x-ray angiography. Chemical analysis of 2 thrombi demonstrated 99 to 147 micromol/L Gd. CONCLUSIONS We demonstrate the feasibility of MRI of coronary thrombus and in-stent thrombosis using a novel fibrin-binding molecular MR contrast agent. Potential applications include detection of coronary in-stent thrombosis or thrombus burden in patients with acute coronary syndromes.
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Affiliation(s)
- René M Botnar
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass 02215, USA.
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18
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Miyamoto A, Prieto AR, Friedl SE, Lin FC, Muller JE, Nesto RW, Abela GS. Atheromatous plaque cap thickness can be determined by quantitative color analysis during angioscopy: implications for identifying the vulnerable plaque. Clin Cardiol 2004; 27:9-15. [PMID: 14743849 PMCID: PMC6654103 DOI: 10.1002/clc.4960270104] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary angioscopy in acute myocardial infarction has frequently revealed disrupted yellow lesions. Furthermore, postmortem studies have demonstrated that these lesions have thin collagenous caps with underlying lipid-rich cores. HYPOTHESIS We hypothesized that the yellow color is due to visualization of reflected light from the lipid-rich yellow core through a thin fibrous cap. Thus, quantification of yellow color saturation may estimate plaque cap thickness and identify vulnerable plaques. METHODS To test this hypothesis, the feasibility of detecting cap thickness was tested using both a model of lipid-rich plaque and human atherosclerotic plaque. The model was constructed by injecting a yellow beta-carotene-lipid emulsion subendothelially into normal bovine aorta. Human plaque was obtained from cadaver aorta. Digitized images were obtained by angioscopy, and percent yellow saturation was analyzed using a custom computer program. Plaque cap thickness was measured by planimetry of digitized images on stained tissue sections. Percent yellow saturation was then correlated with plaque cap thickness. RESULTS In the bovine model, plaque cap thickness and percent yellow saturation correlated inversely (r2 = 0.91; p = 0.0001). In human plaques, yellow saturation was significantly greater in atheromatous than in white plaques (p < 0.0004). Also, there was a high correlation between plaque cap thickness and yellow saturation at various angles of view between 40 degrees and 90 degrees, the greatest between 50 degrees and 80 degrees (r2 = 0.75 to 0.88). CONCLUSION Plaque cap thickness is a determinant of plaque color, and this can be assessed by quantitative colorimetry. Thus, plaque color by angioscopy may be useful for detecting vulnerable plaques.
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Affiliation(s)
- Akira Miyamoto
- Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
- First Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Alejandro R. Prieto
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, Michigan
| | - Stephan E. Friedl
- Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
| | - Freeman C. Lin
- Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
| | - James E. Muller
- Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard W. Nesto
- Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
- Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | - George S. Abela
- Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, Michigan
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19
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Botnar RM, Perez AS, Witte S, Wiethoff AJ, Laredo J, Hamilton J, Quist W, Parsons EC, Vaidya A, Kolodziej A, Barrett JA, Graham PB, Weisskoff RM, Manning WJ, Johnstone MT. In vivo molecular imaging of acute and subacute thrombosis using a fibrin-binding magnetic resonance imaging contrast agent. Circulation 2004; 109:2023-9. [PMID: 15066940 PMCID: PMC2910574 DOI: 10.1161/01.cir.0000127034.50006.c0] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Plaque rupture with subsequent thrombosis is recognized as the underlying pathophysiology of most acute coronary syndromes and stroke. Thus, direct thrombus visualization may be beneficial for both diagnosis and guidance of therapy. We sought to test the feasibility of direct imaging of acute and subacute thrombosis using MRI together with a novel fibrin-binding gadolinium-labeled peptide, EP-1873, in an experimental animal model of plaque rupture and thrombosis. METHODS AND RESULTS Fifteen male New Zealand White rabbits (weight, approximately 3.5 kg) were made atherosclerotic by feeding a high-cholesterol diet after endothelial aortic injury. Plaque rupture was then induced with the use of Russell's viper venom (RVV) and histamine. Subsequently, MRI of the subrenal aorta was performed before RVV, after RVV, and after EP-1873. Histology was performed on regions suggested by MRI to contain thrombus. Nine rabbits (60%) developed plaque rupture and thrombus, including 25 thrombi visually apparent on MRI as "hot spots" after injection of EP-1873. Histological correlation confirmed all 25 thrombi (100%), with no thrombi seen in the other regions of the aorta. In the remaining 6 rabbits (control) without plaque rupture, no thrombus was observed on the MR images or on histology. CONCLUSIONS We demonstrate the feasibility of in vivo "molecular" MRI for the detection of acute and subacute thrombosis using a novel fibrin-binding MRI contrast agent in an animal model of atherosclerosis and acute/subacute thrombosis. Potential clinical applications include thrombus detection in acute coronary syndromes and stroke.
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Affiliation(s)
- René M Botnar
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass, USA
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20
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Waxman S, Mittleman MA, Zarich SW, Fitzpatrick PJ, Lewis SM, Leeman DE, Shubrooks SJ, Abela GS, Nesto RW. Plaque disruption and thrombus in Ambrose's angiographic coronary lesion types. Am J Cardiol 2003; 92:16-20. [PMID: 12842238 DOI: 10.1016/s0002-9149(03)00457-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lesion eccentricity with irregularities on coronary angiography is associated with ruptured plaques and thrombus based on postmortem and clinical angiographic studies. However, the predictive value of such angiographic markers of plaque disruption and thrombus remains to be determined in vivo. The purpose of this study was to establish whether Ambrose's angiographic coronary lesion types and other angiographic criteria predict the presence of disrupted plaques and thrombus using intracoronary angioscopy. Angioscopy was performed before angioplasty in 60 patients with various coronary syndromes and culprit lesions that were not totally occlusive. Lesions were classified angiographically according to Ambrose's criteria as concentric, type I and II eccentric, and multiple irregularities, or as complex or noncomplex, and then compared with the corresponding angioscopic findings. Disruption and/or thrombus were seen in 17 of 19 type II eccentric lesions and 21 of 23 angiographically complex lesions and had the highest positive predictive value to detect complicated atherosclerotic plaques (type II eccentric lesions: positive predictive value 89%, 95% confidence intervals 67% to 99%; complex lesions: 91%, 95% confidence intervals 72% to 99%). We conclude that Ambrose's type II eccentric stenoses and angiographically complex lesions are strongly associated with disrupted plaques and/or thrombus as assessed by angioscopy in patients and represent unstable plaque substrates.
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Affiliation(s)
- Sergio Waxman
- Division of Cardiology, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
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21
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Abstract
Angioscopy allows direct visualization of the coronary artery lumen and provides detailed information regarding the surface characteristics of the vessel wall and specific lesions causing acute coronary syndromes. Disruption of a plaque, ulceration, tears, fissures, lipid-rich or fibrous lesions, and luminal or mural thrombus can be readily detected in vivo. Characterization of culprit lesions in various coronary syndromes reveals the different mechanisms of ischemia. The predominant lesion in acute myocardial infarction is an ulcerated, yellow plaque with thrombus. In unstable angina, different substrates can be seen, from the lipid-rich lesion with thrombus to the fibrous smooth plaque, reflecting a varied physiopathology. Because of its ability to detect superficial lipid pools, angioscopy may be valuable for the detection of vulnerable plaques.
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Affiliation(s)
- Adam J Saltzman
- Cardiovascular Division, Department of Internal Medicine, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA
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22
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Mouhayar EN, Blankenship JC, Fenster BD, Iliadis EA, McConnell TR. Coronary artery "pseudothrombus" due to collateral flow artifact distal to left circumflex coronary stenosis. J Interv Cardiol 2002; 15:425-9; discussion 429-30. [PMID: 12440191 DOI: 10.1111/j.1540-8183.2002.tb01081.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Since the complexity, morbidity, and costs of coronary interventions are increased when coronary thrombus is present, identification of the cause of an angiographic filling defect is potentially important. We present a case report and review our experience with a flow artifact that mimicked thrombus ("pseudothrombus") in the setting of a severe proximal stenosis in the left circumflex coronary artery.
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Affiliation(s)
- Elie N Mouhayar
- Geisinger Medical Center Danville, 100 N. Academy Ave., Danville, PA 17822-2160, USA
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23
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Corti R, Osende JI, Fayad ZA, Fallon JT, Fuster V, Mizsei G, Dickstein E, Drayer B, Badimon JJ. In vivo noninvasive detection and age definition of arterial thrombus by MRI. J Am Coll Cardiol 2002; 39:1366-73. [PMID: 11955857 DOI: 10.1016/s0735-1097(02)01754-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the potential of magnetic resonance (MR) to detect arterial thrombotic obstruction and define thrombus age. BACKGROUND; Arterial thrombi underlie the clinical consequences of atherosclerosis and are not reliably detected by current noninvasive diagnostic techniques. METHODS Carotid thrombi were induced in swine (n = 7) by arterial injury. Serial high-resolution in vivo MR images were obtained using black-blood T1-weighted (T1W) and T2-weighted (T2W) sequences in a clinical 1.5T MR system at 6 h, 1 day and at 1, 2, 3, 6 and 9 weeks. At each time point one animal was sacrificed and the occluded carotid artery processed for histopathology. Thrombus signal intensity (SI) was normalized to that of the adjacent muscle. Thrombus age was assessed based on MR appearance by two blinded independent observers. RESULTS Thrombus appearance and relative SI revealed characteristic temporal changes in multicontrast-weighted MR images, reflecting histologic changes in the composition. Acute thrombus appeared very bright on the T2W images, facilitating the detection. Signal intensity was 197 +/- 25% at 6 h, peaking at 1 week (246 +/- 51%), reaching a plateau by 6 weeks (120 +/- 15%). At six weeks, complete thrombus organization was confirmed histologically. The T1W images had similar pattern with lower SI than T2W. Age definition using visual appearance was highly accurate (Pearson's chi-square with 4 df ranging from 96 to 132 and Cohen's kappa at 0.81 to 0.94). Agreement between observers was substantial (Pearson chi-square with 4 df = 91.5, kappa = 0.79). CONCLUSIONS Magnetic resonance imaging is a promising tool to noninvasively detect arterial thrombosis. Measurement of SI and the characteristic visual appearance of the thrombus have the potential to define thrombus age.
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Affiliation(s)
- Roberto Corti
- Cardiovascular Biology Research Laboratory, Mount Sinai Medical Center, New York, New York, USA
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24
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Yamada T, Nakagawa Y, Hamasaki N, Nobuyoshi M. Usefulness of intracoronary angioscopy for elucidating the cause of subacute thrombosis after stenting. JAPANESE CIRCULATION JOURNAL 2001; 65:232-5. [PMID: 11266200 DOI: 10.1253/jcj.65.232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Stent thrombosis is rare with anti-platelet therapy, which consists of aspirin and ticlopidine as a post-stenting administration. A 77-year-old man had repeated stent thrombosis, which was not predicted by coronary angiography, despite using contemporary periprocedural anti-platelet therapy. Only intravascular fiberscopy was able to detect the cause of the stent thrombosis.
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Affiliation(s)
- T Yamada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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