Department of Cardiology, OhioHealth Heart and Vascular, Riverside Methodist Hospital, Columbus, Ohio.
Department of Cardiovascular Pathology, CVPath Institute, Inc., Gaithersburg, Maryland.
Catheter Cardiovasc Interv. 2021 Jun 1;97(7):1422-1429. doi: 10.1002/ccd.29500. Epub 2021 Feb 1.
Mechanical thrombectomy is increasingly being used as an alternative to pharmacologic therapies for the treatment of patients with acute deep venous thrombosis (DVT) and pulmonary embolism (PE) and allows direct histopathologic comparison of thrombi extracted from living patients. We performed histopathologic analysis to thrombi extracted from cases of DVT and PE to gain insights into their relative cellular compositions.
Thrombus retrieved using a catheter-based thrombectomy system (ClotTriever for lower extremity DVT and FlowTriever for PE) from the 17 patients (7 DVT cases and 10 PE cases) were histologically evaluated. Histological features were used to estimate their age and pathological characteristics.
The thrombus in all cases were composed of fibrin, platelets, red blood cells, and acute inflammatory cells. The weights of thrombus obtained from DVT versus PE cases were heavier (DVT 7.2 g (g) (5.6-10.2) vs. PE 4.8 g (3.6-6.8), p = .01). Overall thrombus healing (i.e., thrombus composed of smooth muscle cells, endothelial cells, and proteoglycans) was different between DVT and PE cases. 6/7 (86%) with features of late stage healing were from DVT cases while only three of ten (30%) were from PE cases while PE contained more acute thrombi with 7/10 (70%) stage 2 as compared 1/7 (14%) for DVT (p = .0498).
This study is the first to directly compare the histology of extracted thrombus in DVT versus PE cases from patients with clinical events. Overall PE cases demonstrated significantly earlier stage thrombus with a larger component of red blood cells.
机械血栓切除术越来越多地被用作治疗急性深静脉血栓形成（DVT）和肺栓塞（PE）患者的药物治疗的替代方法，并允许对从活体患者中提取的血栓进行直接组织病理学比较。我们对从 DVT 和 PE 病例中提取的血栓进行了组织病理学分析，以深入了解它们的相对细胞组成。
使用基于导管的血栓切除术系统（ClotTriever 用于下肢 DVT 和 FlowTriever 用于 PE）从 17 名患者（7 例 DVT 病例和 10 例 PE 病例）中提取血栓进行组织学评估。组织学特征用于估计其年龄和病理特征。
所有病例的血栓均由纤维蛋白、血小板、红细胞和急性炎症细胞组成。从 DVT 与 PE 病例中获得的血栓重量更重（DVT 7.2g（g）（5.6-10.2）与 PE 4.8g（3.6-6.8），p=0.01）。DVT 和 PE 病例的整体血栓愈合（即由平滑肌细胞、内皮细胞和蛋白聚糖组成的血栓）不同。6/7（86%）具有晚期愈合特征的来自 DVT 病例，而只有 10/10（30%）来自 PE 病例，而 PE 包含更多的急性血栓，7/10（70%）为 2 期，而 DVT 为 1/7（14%）（p=0.0498）。
本研究首次直接比较了来自有临床事件的患者的 DVT 与 PE 病例中提取的血栓的组织学。总体而言，PE 病例的血栓更早，红细胞成分更大。
