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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

Title: 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
Authors: Riegger, J
Byrne, RA
Joner, M
Chandraratne, S
Gershlick, AH
Ten Berg, JM
Adriaenssens, T
Guagliumi, G
Godschalk, TC
Neumann, F-J
Trenk, D
Feldman, LJ
Steg, PG
Desmet, W
Alfonso, F
Goodall, AH
Wojdyla, R
Dudek, D
Philippi, V
Opinaldo, S
Titova, A
Malik, N
Cotton, J
Jhagroe, DA
Heestermans, AACM
Sinnaeve, P
Vermeersch, P
Valina, C
Schulz, C
Kastrati, A
Massberg, S
Item Type: Journal Article
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 mm2 vs. late: 2485 ± 1778 per mm2; P = 0.44); neutrophils represented the most prominent subset (early: 1364 ± 923 per mm2 vs. late: 1428 ± 1023 per mm2; 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.
Issue Date: 30-Aug-2015
Date of Acceptance: 6-Aug-2015
URI: http://hdl.handle.net/10044/1/38728
DOI: http://dx.doi.org/10.1093/eurheartj/ehv419
ISSN: 1522-9645
Publisher: Oxford University Press
Start Page: 1538
End Page: 1549
Journal / Book Title: European Heart Journal
Volume: 37
Issue: 19
Copyright Statement: © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Eosinophils
Histopathology
Neutrophils
Neutrophil extracellular traps
Platelets
Stent thrombosis
Thrombus aspiration
DRUG-ELUTING STENTS
ACUTE CORONARY SYNDROMES
INNATE IMMUNITY
HYPERSENSITIVITY
IMPLANTATION
COAGULATION
GENERATION
PLATELETS
RISK
VIVO
Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Investigators
Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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