Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway.
Scand J Clin Lab Invest. 2012 Feb;72(1):23-8. doi: 10.3109/00365513.2011.616220. Epub 2011 Dec 12.
The purpose of this study was to measure the in vivo platelet activation and thrombin generation in arterial blood after passing a subintimal conduit.
Subintimal percutaneous transluminal angioplasty (SPTA) is a technique where a subintimal channel is created, allowing recanalization of long peripheral arterial occlusion. From 10 patients with intermittent claudication, undergoing successful SPTA for femoropopliteal occlusive disease, we collected antecubital venous blood samples immediately before treatment, preprocedural arterial blood samples taken at the entry level proximal to the vessel occlusion, and subsequently at the reentry level after successful recanalization. Venous follow-up blood samples were taken after 24 hours. Plasma concentrations of β-thromboglobulin (β-TG), RANTES, and Prothrombin fragment (F1 + 2), were determined by immunoassay. Fibrinogen binding to platelets, leukocyte-platelet adhesion, and P-selectin were determined by flow cytometry.
We found a statistically significant transluminal increase in the plasma concentrations of RANTES, β-TG and F1 + 2 (p = 0.002, 0.001 and 0.001 respectively), which all normalized within 24 hours. Platelet-leukocyte aggregates significantly decreased after 24 hours compared with preprocedural and preentry levels (3.26% versus 5.26 %, p = 0.017). P-selectin expression on circulating platelets was statistically significantly increased in the blood sample taken at the re-entry level compared with the pre-procedural and pre-entry level (p = 0.007). After 24 hours there was no statistically significant difference to pre-procedural levels. There was no significant change in platelet fibrinogen binding at any levels.
When passing a subintimal conduit, in vivo sampled blood demonstrated an extremely rapid and substantial uniform platelet activation and thrombin generation.
本研究旨在测量通过内膜下导管后动脉血中的体内血小板活化和凝血酶生成情况。
内膜下经皮腔内血管成形术（SPTA）是一种创建内膜下通道的技术，可使长段外周动脉闭塞再通。我们从 10 例间歇性跛行的患者中选取，这些患者因股腘动脉闭塞性疾病成功进行了 SPTA，我们在治疗前立即采集肘前静脉血样本，在血管闭塞近端的术前动脉血样本，以及随后在成功再通后的再进入水平采集。在 24 小时后采集静脉随访血样。通过免疫测定法测定β-血栓球蛋白（β-TG）、RANTES 和凝血酶原片段（F1+2）的血浆浓度。通过流式细胞术测定纤维蛋白原与血小板的结合、白细胞-血小板黏附以及 P-选择素。
我们发现 RANTES、β-TG 和 F1+2 的血浆浓度在跨壁水平有统计学显著增加（p = 0.002、0.001 和 0.001），所有这些都在 24 小时内恢复正常。与术前和预进入水平相比，24 小时后血小板-白细胞聚集体显著减少（3.26%比 5.26%，p = 0.017）。与术前和预进入水平相比，在再进入水平采集的血样中，循环血小板上的 P-选择素表达有统计学显著增加（p = 0.007）。24 小时后，与术前水平无统计学显著差异。在任何水平，血小板纤维蛋白原结合均无显著变化。
当通过内膜下导管时，体内取样的血液显示出极其迅速和大量的均匀血小板活化和凝血酶生成。
