Impact of primitive cells in intracoronary thrombi on lesion prognosis: temporal analysis of cellular constituents of thrombotic material obtained from patients with acute coronary syndrome (original) (raw)
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Cardiovascular Pathology, 2014
Thrombus aspiration in the setting of primary percutaneous coronary intervention is a recently recommended technique that facilitates thrombus removal from the culprit lesions in acute myocardial infarction (AMI) patients. Thrombectomy specimens from 50 patients with symptoms of AMI lasting usually not more than 12 h were examined by methods of routine histology, immunohistochemistry (IHC), and electron microscopy (ELMI). In 36 patients, there were fresh thrombi, in 10 older thrombi (8 of them with simultaneous presence of a fresh thrombi) and in 3 atheroma material only (in additional 7 patients atheroma material was admixed to the thrombi), and in one patient, there was carcinoma embolus. To help to distinguish between fresh and older thrombi, we recommend IHC (presence of macrophages and endothelia) and ELMI (loss of density of the erythrocyte matrix and presence of macrophages). On the other hand, changes of neutrophils (IHC degranulation/lysis) and of platelets (ELMI degranulation) appear early and thus contribute little to distinguishing between fresh and older thrombi. It could be concluded that, in a substantial proportion of patients with AMI, there is a discrepancy between duration of the symptoms and microscopic picture of the coronary thrombus. The thrombus may apparently be symptomless for a period of days or even weeks.
Journal of Cellular and Molecular Medicine, 2012
Acute coronary syndromes and acute myocardial infarctions are often related to plaque rupture and the formation of thrombi at the site of the rupture. We examined fresh coronary thrombectomy specimens from patients with acute coronary syndromes and assessed their structure and cellularity. The thrombectomy specimens consisted of platelets, erythrocytes and inflammatory cells. Several specimens contained multiple cholesterol crystals. Culture of thrombectomy specimens yielded cells growing in various patterns depending on the culture medium used. Culture in serum-free stem cell enrichment medium yielded cells with features of endothelial progenitor cells which survived in culture for a year. Immunohistochemical analysis of the thrombi revealed cells positive for CD34, cells positive for CD15 and cells positive for desmin in situ, whereas cultured cell from thrombi was desmin positive but pancytokeratin negative. Cells cultured in endothelial cell medium were von Willebrand factor positive. The content of coronary thrombectomy specimens is heterogeneous and consists of blood cells but also possibly cells from the vascular wall and cholesterol crystals. The culture of cells contained in the specimens yielded multiplying cells, some of which demonstrated features of haematopoietic progenitor cells and which differentiated into various cell-types.
The American Journal of Cardiology, 1996
This study compares the ability of intracorona uhrasound (KUS) to identify thrombus by means it actual criteria, with the histologic studies of tissues removed by directional atherectomy in patients tnzat$ previously with thrcnnbolytic therapy. Coromm~ea~ra and intravascular ultrasound imagi 3 c?fwe atherectomy in 34 'era tR2 0 had received intravenous thrombdytic py for acute myacurdial infarction a mean of 6 days before. The lesi and the percen angiogmm. 7 of stenosis were The u trasound chamcteristics of the narrowin were described as intraluminal thrombus, mural th %u rom 5, mixed plaque, and dense plaque. Thirty patients were studied. Thmmbus was suspected in 8 E tients on angiogmphy. 8y KUS, the presence of throms was predicted in 21 patients. Histologic studies of excised tissues found thrombus in 20 of the 30 patients. When KUS was compared with histology, the true-positive rate was 80% and he false-positive rate was 50%; the true-negative rate was 50% ad he falsenegative mte was 20%. The correlation between observers was h' h. These observations suggest that KUS may be useb?in identifying fresh thrombus. The findings of this study help to confirm the criteria for diagnosing intraluminal thrombus by KUS imaging. (Am J Cardiol 1996;77344-349)
Journal of Thrombosis and Thrombolysis, 2010
Using scanning electron microscopy we analyzed thrombotic material removed from coronary bypass grafts in a 57-year-old woman with multilevel atherosclerosis presenting with acute myocardial infarction (AMI). A white thrombotic material removed from the marginal branch bypass that contained large amounts of activated platelets displaying pseudopodia clearly visible at a higher magnification with a relatively low amount of fibrin. The other thrombus obtained from the right posterior descendent branch (RPD) bypass showed a highly organized fibrin structure composed of thicker fibers with low amounts of cellular components. Our findings indicate that the thrombus structure is different in AMI patients in whom the infarct-related vessel is vein anastomosis compared to those with a native coronary artery occluded. These findings help explain resistance of such thrombi to fibrinolysis and faster plaque growth related to fibrin accumulation.
World journal of cardiology, 2016
In patients with ST-elevation myocardial infarction, recurrent cardiovascular events still remain the main cause of morbidity and mortality, despite significant improvements in antithrombotic therapy. We sought to review data regarding coronary thrombus analysis provided by studies using manual aspiration thrombectomy (AT), and to discuss how insights from this line of investigation could further improve management of acute coronary disease. Several studies investigated the fresh specimens retrieved by AT using techniques such as traditional morphological evaluation, optical microscopy, scanning electron microscopy, magnetic resonance imaging, and immunohistochemistry. These approaches have provided a better understanding of the composition and dynamics of the human coronary thrombosis process, as well as its relationship with some clinical outcomes. Recent data signaling to new antithrombotic therapeutic targets are still emerging.
Diagnostic and therapeutic endoscopy, 2000
The purpose of this study was to evaluate intracoronary thrombi in the culprit lesions in patients with acute myocardial infarction (AMI) by angioscopy, and to compare them with clinical and angiographic features. We angioscopically observed the culprit coronary lesions in 66 patients with AMI (55 males and 11 females, 63.9+/-15.4 years old) just before interventional therapy. Thrombi were observed in 42 of 66 lesions (64%), namely, red thrombi in 16, mixed thrombi in 15, white thrombi in 11. In patients with complete obstruction (TIMI grade 0 and I), red thrombi were more frequently observed than mixed or white thrombi. On the other hand, in patients with incomplete obstruction (TIMI grade II and III), white thrombi were more frequently observed than the others. Angiographically, haziness and filling defect were significantly more frequently observed in patients with red thrombi than the others (p<0.05). The distance from proximal side branch to thrombi tended to be longer in pa...