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Silver MJ, Kawakami R, Jolly MA, Huff CM, Phillips JA, Sakamoto A, Kawai K, Kutys B, Guo L, Cornelissen A, Mori M, Sato Y, Romero M, Virmani R, Finn AV. Histopathologic analysis of extracted thrombi from deep venous thrombosis and pulmonary embolism: Mechanisms and timing. Catheter Cardiovasc Interv 2021; 97:1422-1429. [PMID: 33522027 DOI: 10.1002/ccd.29500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/23/2020] [Accepted: 12/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mechanical thrombectomy is increasingly being used as an alternative to pharmacologic therapies for the treatment of patients with acute deep venous thrombosis (DVT) and pulmonary embolism (PE) and allows direct histopathologic comparison of thrombi extracted from living patients. We performed histopathologic analysis to thrombi extracted from cases of DVT and PE to gain insights into their relative cellular compositions. METHODS Thrombus retrieved using a catheter-based thrombectomy system (ClotTriever for lower extremity DVT and FlowTriever for PE) from the 17 patients (7 DVT cases and 10 PE cases) were histologically evaluated. Histological features were used to estimate their age and pathological characteristics. RESULTS The thrombus in all cases were composed of fibrin, platelets, red blood cells, and acute inflammatory cells. The weights of thrombus obtained from DVT versus PE cases were heavier (DVT 7.2 g (g) (5.6-10.2) vs. PE 4.8 g (3.6-6.8), p = .01). Overall thrombus healing (i.e., thrombus composed of smooth muscle cells, endothelial cells, and proteoglycans) was different between DVT and PE cases. 6/7 (86%) with features of late stage healing were from DVT cases while only three of ten (30%) were from PE cases while PE contained more acute thrombi with 7/10 (70%) stage 2 as compared 1/7 (14%) for DVT (p = .0498). CONCLUSION This study is the first to directly compare the histology of extracted thrombus in DVT versus PE cases from patients with clinical events. Overall PE cases demonstrated significantly earlier stage thrombus with a larger component of red blood cells.
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Affiliation(s)
- Mitchell J Silver
- Department of Cardiology, OhioHealth Heart and Vascular, Riverside Methodist Hospital, Columbus, Ohio
| | - Rika Kawakami
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Michael A Jolly
- Department of Cardiology, OhioHealth Heart and Vascular, Riverside Methodist Hospital, Columbus, Ohio
| | - Christopher M Huff
- Department of Cardiology, OhioHealth Heart and Vascular, Riverside Methodist Hospital, Columbus, Ohio
| | - John A Phillips
- Department of Cardiology, OhioHealth Heart and Vascular, Riverside Methodist Hospital, Columbus, Ohio
| | - Atsushi Sakamoto
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Kenji Kawai
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Bob Kutys
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Liang Guo
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Anne Cornelissen
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Masayuki Mori
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Yu Sato
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Maria Romero
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland
| | - Aloke V Finn
- Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland.,Department of Medicine, University of Maryland, Baltimore, Maryland
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Kawakami R, Sakamoto A, Kawai K, Gianatti A, Pellegrini D, Nasr A, Kutys B, Guo L, Cornelissen A, Mori M, Sato Y, Pescetelli I, Brivio M, Romero M, Guagliumi G, Virmani R, Finn AV. Pathological Evidence for SARS-CoV-2 as a Cause of Myocarditis: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 77:314-325. [PMID: 33478655 PMCID: PMC7816957 DOI: 10.1016/j.jacc.2020.11.031] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
To investigate whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)–induced myocarditis constitutes an important mechanism of cardiac injury, a review was conducted of the published data and the authors’ experience was added from autopsy examination of 16 patients dying of SARS-CoV-2 infection. Myocarditis is an uncommon pathologic diagnosis occurring in 4.5% of highly selected cases undergoing autopsy or endomyocardial biopsy. Although polymerase chain reaction–detectable virus could be found in the lungs of most coronavirus disease-2019 (COVID-19)–infected subjects in our own autopsy registry, in only 2 cases was the virus detected in the heart. It should be appreciated that myocardial inflammation alone by macrophages and T cells can be seen in noninfectious deaths and COVID-19 cases, but the extent of each is different, and in neither case do such findings represent clinically relevant myocarditis. Given its extremely low frequency and unclear therapeutic implications, the authors do not advocate use of endomyocardial biopsy to diagnose myocarditis in the setting of COVID-19.
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Affiliation(s)
- Rika Kawakami
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Atsushi Sakamoto
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Kenji Kawai
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Andrea Gianatti
- Department of Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Dario Pellegrini
- Department of Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Ahmed Nasr
- Department of Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Bob Kutys
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Liang Guo
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Anne Cornelissen
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Masayuki Mori
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Yu Sato
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Irene Pescetelli
- Department of Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Matteo Brivio
- Department of Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Romero
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Giulio Guagliumi
- Department of Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA
| | - Aloke V Finn
- Department of Cardiovascular Pathology, CVPath Institute, Inc. Gaithersburg, Maryland, USA; Department of Medicine, University of Maryland, Baltimore, Maryland, USA.
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