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Sanjit S Jolly - One of the best experts on this subject based on the ideXlab platform.
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Reply: Thrombus Aspiration in Hyperglycemic Patients With High Inflammation Levels in Coronary Thrombus
Journal of the American College of Cardiology, 2019Co-Authors: Sanjit S JollyAbstract:We thank Dr. Sardu and colleagues for their interest in our work [(1)][1]. Dr. Sardu and colleagues hypothesize that size of Thrombus is only 1 aspect to the benefit of Thrombus aspiration and that the pro-inflammatory composition of Thrombus may be important. They performed an observational study
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Thrombus aspiration in patients with high Thrombus burden in the total trial
Journal of the American College of Cardiology, 2018Co-Authors: Sanjit S Jolly, John A Cairns, Shahar Lavi, Warren J Cantor, Asim N Cheema, Sasko Kedev, Raul Moreno, Ivo Bernat, Goran StankovicAbstract:Abstract Background Routine Thrombus aspiration in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) does not improve clinical outcomes. However, there is remaining uncertainty about the potential benefit in those patients with high Thrombus burden, where there is a biological rationale for greater benefit. Objectives The purpose of this study was to evaluate the benefit of Thrombus aspiration among STEMI patients with high Thrombus burden. Methods TOTAL (ThrOmbecTomy with PCI vs. PCI ALone in patients with STEMI) was a randomized trial of routine manual thrombectomy versus PCI alone in patients with STEMI (n = 10,732). High Thrombus burden (Thrombolysis In Myocardial Infarction Thrombus grade ≥3) was a pre-specified subgroup. Results The primary outcome of cardiovascular (CV) death, MI, cardiogenic shock, or heart failure was not different at 1 year with Thrombus aspiration in patients with high Thrombus burden (8.1% vs. 8.3% Thrombus aspiration; hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.84 to 1.13) or low Thrombus burden (6.0% vs. 5.0% Thrombus aspiration; HR: 1.22; 95% CI: 0.73 to 2.05; interaction p = 0.41). However, among patients with high Thrombus burden, stroke at 30 days was more frequent with Thrombus aspiration (31 [0.7%] Thrombus aspiration vs. 16 [0.4%] PCI alone, HR: 1.90; 95% CI: 1.04 to 3.48). In the high Thrombus burden group, Thrombus aspiration did not significantly improve CV mortality at 30 days (HR: 0.78; 95% CI: 0.61 to 1.01; p = 0.06) and at 1 year (HR: 0.88; 95% CI: 0.72 to 1.09; p = 0.25). Irrespective of treatment assignment, high Thrombus burden was an independent predictor of death (HR: 1.78; 95% CI: 1.05 to 3.01). Conclusions In patients with high Thrombus burden, routine Thrombus aspiration did not improve outcomes at 1 year and was associated with an increased rate of stroke. High Thrombus burden is still an important predictor of outcome in STEMI. (A Trial of routine aspiration ThrOmbecTomy with PCI vs. PCI ALone in patients with STEMI [TOTAL]; NCT01149044)
Per Eriksson - One of the best experts on this subject based on the ideXlab platform.
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The Intraluminal Thrombus as a Source of Proteolytic Activity
Annals of the New York Academy of Sciences, 2006Co-Authors: Jesper Swedenborg, Per ErikssonAbstract:Most abdominal aortic aneurysms (AAAs) with a diameter indicating need for surgical repair contain intraluminal Thrombus (ILT). The development of AAA is linked to degradation of elastin and collagen. These changes are more pronounced in the aneurysm wall covered by the ILT, which also shows more signs of inflammation and is thinner compared to the aneurysm wall exposed to flowing blood. The rate of increase in diameter of AAA correlates with increased Thrombus growth and rupture. CT examinations of patients with rupture have demonstrated contrast appearing in the Thrombus suggesting bleeding into it. Studies using gene array of human aneurysm specimens have shown that most matrix metalloproteinases (MMP) were upregulated in the Thrombus-free wall. Analyses by zymography, however, demonstrate gelatinase activity in the interface between the Thrombus and the underlying wall and in the media of the wall not covered by a Thrombus. The Thrombus contains large amounts of neutrophils. Neutrophil gelatinase associated lipocalin (NGAL) is involved in the regulation of MMP-9 activity and prevents its inactivation, thus augmenting the proteolytic effect. It has been identified in all layers of the ILT. The presence of NGAL/MMP-9 complexes throughout the Thrombus and in the Thrombus-covered wall may contribute to the increased proteolytic degradation seen in this wall segment. In conclusion, the presence, growth, and thickness of the ILT have been shown to be associated with growth and risk of rupture. The wall underlying the Thrombus is thinner and shows more signs of proteolytic degradation. Increased proteolytic activity by MMP-9 may be mediated by binding to NGAL.
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Difference in Matrix-Degrading Protease Expression and Activity Between Thrombus-Free and Thrombus-Covered Wall of Abdominal Aortic Aneurysm
Arteriosclerosis thrombosis and vascular biology, 2005Co-Authors: Monsur Kazi, Chaoyong Zhu, Joy Roy, Gabrielle Paulsson-berne, Anders Hamsten, Jesper Swedenborg, Ulf Hedin, Per ErikssonAbstract:Objective— It has been suggested that the intraluminal Thrombus of abdominal aortic aneurysms (AAAs) predisposes for AAA rupture. Here, we examined the possibility that the intraluminal Thrombus influences expression and activity of matrix-degrading proteases in the AAA wall. Methods and Results— Twenty patients undergoing elective repair of AAAs were included. From each patient, specimens from both Thrombus-covered and Thrombus-free wall were taken for analysis. Gene arrays and quantitative real-time polymerase chain reaction showed that matrix metalloproteinase (MMP)-1, -7, -9, and -12 expressions were upregulated in the Thrombus-free wall compared with the Thrombus-covered wall. Immunohistochemistry confirmed the differential expression of MMP-9 but also localized MMP-9 to the interface between the Thrombus and the underlying vessel wall. MMP-9 expression was colocalized with the presence of macrophages. Similar expression patterns were observed for urokinase plasminogen activator (uPA), uPA receptor, and plasminogen activator inhibitor-1. Gelatinase activity was detected in the same regions as MMP-9 protein expression, ie, within the Thrombus-free wall and in the interface between the Thrombus and the underlying wall. Conclusion— The present work demonstrates that protease expression and activity differs within the aneurysm wall. The source and activity of the proteases responsible for the degradation of the Thrombus-covered wall need to be further determined.
Sanjeeva P Kalva - One of the best experts on this subject based on the ideXlab platform.
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clinical sequelae of Thrombus in an inferior vena cava filter
CardioVascular and Interventional Radiology, 2010Co-Authors: Iftikhar Ahmad, Kalpana Yeddula, Stephan Wicky, Sanjeeva P KalvaAbstract:The purpose of this study was to assess the long-term clinical sequelae of inferior vena cava (IVC) filter Thrombus and the effect of anticoagulation on filter Thrombus. Of 1,718 patients who had IVC filters placed during 2001-2008, 598 (34.8%) had follow-up abdominal CT. Filter Thrombus was seen in 111 of the 598 (18.6%). There were 44 men (39.6%). The mean age at filter placement was 64 years. The medical diseases included cancer in 64, trauma in 15, stroke in 12, and others in 20. The frequency of filter Thrombus on CT and asymptomatic filter Thrombus on CT was calculated. The frequency of pulmonary embolism (PE) in patients with filter Thrombus was calculated. The frequency of Thrombus progression or regression (on CT, available in 56) was calculated. The effect of anticoagulation on filter Thrombus regression/progression was evaluated using the Fisher exact test by comparing the group of patients who received anticoagulants versus those who did not. A P-value of <0.05 was considered significant. The overall frequency of filter Thrombus was 18.6%. Total occlusion of the IVC filter was seen in 12 of 598 (2%). The filter Thrombus was asymptomatic in 110 (18.3%). Filter Thrombus was detected after a median of 35 days (range, 0-2082) following filter placement. Thrombus extended above the filter in 4 (3.6%); IVC Thrombus below the filter was seen in 35(31.5%). Thrombus in the filter occluded <25% of the filter volume in 58 (52.3%), 25-50% in 21 (18.9%), and 50-75% in 20 (18%). Total IVC occlusion was seen in 12 (10.8%). Eighty-three patients received anticoagulation. Sixteen patients developed symptoms of PE. PE was confirmed on CT in 3 of 15 (2.7%). On follow-up, filter Thrombus regressed completely in 19 (33.9%) after a median of 6 months. Filter Thrombus decreased in size in 13 (23.2%) and it progressed without IVC occlusion in 7 (12.6%). In one (1.7%), filter Thrombus progressed to IVC occlusion. Filter Thrombus remained stable in 16 (28.6%). There was no significant difference in Thrombus regression or progression rates whether or not the patients received anticoagulation for filter Thrombus. In conclusion, asymptomatic Thrombus in the filter is common and it rarely progresses to complete caval occlusion. Anticoagulation has little effect on the resolution of filter thrombosis and future occurrence of PE.
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Clinical Sequelae of Thrombus in an Inferior Vena Cava Filter
Cardiovascular and interventional radiology, 2009Co-Authors: Iftikhar Ahmad, Kalpana Yeddula, Stephan Wicky, Sanjeeva P KalvaAbstract:The purpose of this study was to assess the long-term clinical sequelae of inferior vena cava (IVC) filter Thrombus and the effect of anticoagulation on filter Thrombus. Of 1,718 patients who had IVC filters placed during 2001-2008, 598 (34.8%) had follow-up abdominal CT. Filter Thrombus was seen in 111 of the 598 (18.6%). There were 44 men (39.6%). The mean age at filter placement was 64 years. The medical diseases included cancer in 64, trauma in 15, stroke in 12, and others in 20. The frequency of filter Thrombus on CT and asymptomatic filter Thrombus on CT was calculated. The frequency of pulmonary embolism (PE) in patients with filter Thrombus was calculated. The frequency of Thrombus progression or regression (on CT, available in 56) was calculated. The effect of anticoagulation on filter Thrombus regression/progression was evaluated using the Fisher exact test by comparing the group of patients who received anticoagulants versus those who did not. A P-value of
Marc Carrier - One of the best experts on this subject based on the ideXlab platform.
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The risk of venous thromboembolism in renal cell carcinoma patients with residual tumor Thrombus.
Journal of Thrombosis and Haemostasis, 2014Co-Authors: R. Ihaddadene, D. W. Yokom, Grégoire Le Gal, P. Moretto, C. M. Canil, Aurélien Delluc, N. Reaume, Marc CarrierAbstract:BACKGROUND: The clinical importance of tumor Thrombus in patients with renal cell carcinoma is unknown. We sought to determine the long-term risk of venous thromboembolism (VTE) in patients with residual tumor Thrombus postextraction, and to evaluate the impact of residual tumor Thrombus on overall survival. PATIENTS/METHODS: A cohort study of patients with stage III-IV renal cell carcinoma undergoing nephrectomy was undertaken. The primary endpoint was the risk of VTE during a 2-year follow-up period. The secondary endpoint was 2-year overall survival. RESULTS: A total of 170 surgical renal cell carcinoma patients were included, 97 (57.1%) of whom had tumor Thrombus. Patients with residual tumor Thrombus following surgery had a higher risk of developing VTE than those with complete tumor Thrombus resection (hazard ratio [HR] 8.7, 95% confidence interval [CI] 1.7-43.4) and no tumor Thrombus (HR 6.5, 95% CI 1.7-24.7). Patient with residual tumor Thrombus did not have worse overall survival than those with tumor Thrombus completely resected or those without tumor Thrombus. CONCLUSIONS: The presence of residual tumor Thrombus is an important risk factor for VTE among renal cell carcinoma patients.
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Increased risk of preoperative venous thromboembolism in patients with renal cell carcinoma and tumor Thrombus.
Journal of Thrombosis and Haemostasis, 2014Co-Authors: D. W. Yokom, R. Ihaddadene, Grégoire Le Gal, P. Moretto, C. M. Canil, N. Reaume, Marc CarrierAbstract:BACKGROUND: The clinical impact of a tumor Thrombus in renal cell carcinoma (RCC) patients awaiting radical nephrectomy and thrombectomy is unknown. OBJECTIVE: To determine the incidence of venous thromboembolism (VTE) in RCC patients with tumor Thrombus prior to nephrectomy. PATIENTS/METHODS: We conducted a retrospective cohort study including all late-stage (stage 3-4 excluding T1-2 N0M0)) RCC patients that underwent a radical nephrectomy at our institution between January 1, 2005 and July 1. Tumor Thrombus was defined as the presence of an intra-luminal filling defect in the renal, hepatic, portal or IVC directly extending from a renal mass detected on computed tomography. RESULTS: A total of 176 patients were included in the study. Fifty-three (30.1%) patients had tumor Thrombus diagnosed on imaging Three patients with tumor Thrombus (5.7%; 95% CI: 1.4 to 16.8%) developed a VTE while awaiting radical nephrectomy whereas none (0%; 95% CI: 0 to 2.9%) of the patients without a tumor Thrombus had an event (p = 0.026). All three events were deep vein thrombosis. Time from tumor Thrombus diagnosis to VTE was 5, 15 and 21 days. CONCLUSIONS: Tumor Thrombus on imaging is a frequent finding among RCC patients awaiting nephrectomy. The presence of tumor Thrombus in these patients increases the incidence of pre-operative VTE. This article is protected by copyright. All rights reserved.
Bijan Modarai - One of the best experts on this subject based on the ideXlab platform.
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magnetic resonance t1 relaxation time of venous Thrombus is determined by iron processing and predicts susceptibility to lysis
Circulation, 2013Co-Authors: Prakash Saha, Marcelo E Andia, Bijan Modarai, Ulrike Blume, Julia Humphries, Ashish Patel, Alkystis Phinikaridou, Colin E Evans, Katherine Mattock, Steven P GroverAbstract:Background—The magnetic resonance longitudinal relaxation time (T1) changes with Thrombus age in humans. In this study, we investigate the possible mechanisms that give rise to the T1 signal in venous thrombi and whether changes in T1 relaxation time are informative of the susceptibility to lysis. Methods and Results—Venous thrombosis was induced in the vena cava of BALB/C mice, and temporal changes in T1 relaxation time correlated with Thrombus composition. The mean T1 relaxation time of Thrombus was shortest at 7days following Thrombus induction and returned to that of blood as the Thrombus resolved. T1 relaxation time was related to Thrombus methemoglobin formation and further processing. Studies in inducible nitric oxide synthase (iNOS−/−)–deficient mice revealed that inducible nitric oxide synthase mediates oxidation of erythrocyte lysis–derived iron to paramagnetic Fe3+, which causes Thrombus T1 relaxation time shortening. Studies using chemokine receptor-2–deficient mice (Ccr2−/−) revealed that the...
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The role of neovascularisation in the resolution of venous Thrombus
Thrombosis and haemostasis, 2005Co-Authors: Bijan Modarai, Julia Humphries, Kevin Burnand, Matthew Waltham, Alberto SmithAbstract:Deep vein thrombosis (DVT) can give rise to chronic debilitating complications, which are expensive to treat. Anticoagulation, the standard therapy for DVT, prevents propagation, but does not remove the existing Thrombus, which undergoes slow natural resolution. Alternative forms of treatment that accelerate resolution may arise from a better understanding of the cellular and molecular pathways that regulate the natural resolution of thrombi. This review will outline our current understanding of the mechanisms of Thrombus resolution and the role of neovascularisation in this process. Novel experimental treatments that may one day find clinical use are also discussed. The process of Thrombus resolution resembles wound healing. The mainly monocytic inflammatory infiltrate, which develops, is associated with the appearance of vascular channels. These cells may drive resolution by encouraging angiogenesis, which contributes to restoration of the vein lumen. Significant numbers of bone marrow-derived progenitor cells have also been found in naturally resolving thrombi, but their precise phenotype and their role in Thrombus recanalisation is unclear. Enhanced Thrombus neovascularisation and rapid vein recanalisation have been achieved in experimental models with proangiogenic agents. Recent reports of the role of bone marrow-derived progenitor cells in the revascularisation of ischaemic tissues suggest that it may be possible to obtain the same effect by delivering pluripotent or lineage specific stem cells into Thrombus. These cells could contribute to Thrombus recanalisation by expressing a variety of proangiogenic cytokines or by lining the new vessels that appear within the Thrombus.
