Histopathological evaluation of thrombus in patients presenting with stent thrombosis. A multicenter European study: a report of the prevention of late stent thrombosis by an interdisciplinary global European effort consortium. Other Scholarly Work

Riegger, Julia, Byrne, Robert A, Joner, Michael et al. (2016). Histopathological evaluation of thrombus in patients presenting with stent thrombosis. A multicenter European study: a report of the prevention of late stent thrombosis by an interdisciplinary global European effort consortium. . EUROPEAN HEART JOURNAL, 37(19), 1538-1549. 10.1093/eurheartj/ehv419

cited authors

  • Riegger, Julia; Byrne, Robert A; Joner, Michael; Chandraratne, Sue; Gershlick, Anthony H; Ten Berg, Jurrien M; Adriaenssens, Tom; Guagliumi, Giulio; Godschalk, Thea C; Neumann, Franz-Josef; Trenk, Dietmar; Feldman, Laurent J; Steg, Philippe Gabriel; Desmet, Walter; Alfonso, Fernando; Goodall, Alison H; Wojdyla, Roman; Dudek, Dariusz; Philippi, Vanessa; Opinaldo, Sheryl; Titova, Anna; Malik, Nikesh; Cotton, James; Jhagroe, Darshni A; Heestermans, Antonius ACM; Sinnaeve, Peter; Vermeersch, Paul; Valina, Christian; Schulz, Christian; Kastrati, Adnan; Massberg, Steffen; Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Investigators

abstract

  • Background

    Stent thrombosis (ST) is a rare but serious complication following percutaneous coronary intervention. Analysis of thrombus composition from patients undergoing catheter thrombectomy may provide important insights into the pathological processes leading to thrombus formation. We performed a large-scale multicentre study to evaluate thrombus specimens in patients with ST across Europe.

    Methods

    Patients presenting with ST and undergoing thrombus aspiration were eligible for inclusion. Thrombus collection was performed according to a standardized protocol and specimens were analysed histologically at a core laboratory. Serial tissue cross sections were stained with haematoxylin-eosin (H&E), Carstairs and Luna. Immunohistochemistry was performed to identify leukocyte subsets, prothrombotic neutrophil extracellular traps (NETs), erythrocytes, platelets, and fibrinogen.

    Results

    Overall 253 thrombus specimens were analysed; 79 (31.2%) from patients presenting with early ST, 174 (68.8%) from late ST; 79 (31.2%) were from bare metal stents, 166 (65.6%) from drug-eluting stents, 8 (3.2%) were from stents of unknown type. Thrombus specimens displayed heterogeneous morphology with platelet-rich thrombus and fibrin/fibrinogen fragments most abundant; mean platelet coverage was 57% of thrombus area. Leukocyte infiltrations were hallmarks of both early and late ST (early: 2260 ± 1550 per mm(2) vs. late: 2485 ± 1778 per mm(2); P = 0.44); neutrophils represented the most prominent subset (early: 1364 ± 923 per mm(2) vs. late: 1428 ± 1023 per mm(2); P = 0.81). Leukocyte counts were significantly higher compared with a control group of patients with thrombus aspiration in spontaneous myocardial infarction. Neutrophil extracellular traps were observed in 23% of samples. Eosinophils were present in all stent types, with higher numbers in patients with late ST in sirolimus-and everolimus-eluting stents.

    Conclusion

    In a large-scale study of histological thrombus analysis from patients presenting with ST, thrombus specimens displayed heterogeneous morphology. Recruitment of leukocytes, particularly neutrophils, appears to be a hallmark of ST. The presence of NETs supports their pathophysiological relevance. Eosinophil recruitment suggests an allergic component to the process of ST.

publication date

  • May 1, 2016

published in

keywords

  • Aged
  • Blood Platelets
  • Coronary Thrombosis
  • Drug-Eluting Stents
  • Eosinophils
  • Female
  • Fibrinogen
  • Graft Occlusion, Vascular
  • Humans
  • Leukocyte Count
  • Lymphocyte Subsets
  • Male
  • Neutrophils
  • Percutaneous Coronary Intervention
  • Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Investigators
  • Prospective Studies
  • Prosthesis Failure
  • Stents
  • Thrombectomy

Digital Object Identifier (DOI)

Medium

  • Print-Electronic

start page

  • 1538

end page

  • 1549

volume

  • 37

issue

  • 19