HISTOLOGICAL ANALYSIS OF THROMBI OBTAINED DURING PERCUTANEOUS CORONARY INTERVENTION: MORPHOLOGICAL AND CLINICAL INTERACTIONS
DOI:
https://doi.org/10.11603/1811-2471.2021.v.i1.11921Keywords:
acute myocardial infarction, coronary thrombus, morphological characteristics of thrombi, percutaneous coronary interventionAbstract
The pathogenesis of acute coronary syndrome is based on the destabilization of atherosclerotic plaque with subsequent thrombosis of the coronary artery. With the introduction of percutaneous coronary interventions in clinical practice it became possible not only to quickly and effectively restore the patency of the infarct-dependent artery, but also to investigate the structure of coronary thrombi in vivo. This information is valuable both for deepening the understanding of the pathogenesis of acute coronary events and for predicting their further course.
The aim – to compare clinical data and histological structure of thrombi in patients with acute myocardial infarction (AMI).
Material and Methods. The study involved 109 patients diagnosed with AMI. Material suitable for histological examination was obtained in 12 cases. Samples were analyzed to determine the histological age of aspirated thrombi, as well as to compare their morphological characteristics and clinical data of patients.
Results. In most cases, aspirated blood clots by macroscopic parameters were classified as "red" – n=10 (83,3 %). "White" blood clots appeared less common – in 2 (16.7 %) cases, and were obtained only if the angina pectoris lasted less than 2 hours. According to microscopy analysis in 3 (25,0 %) cases, blood clots were classified as "fresh", all of them were obtained in the first 6 hours after the development of chest pain. "Lytic" thrombi were found in 7 (58,3 %) patients and in 2 (16,7 %) samples there were signs of "organized" blood clots. When assessing the long-term prognosis in only one case was an episode of re-hospitalization for recurrent myocardial infarction in a patient with a "red" thrombus, which according to microscopy analysis was classified as "lytic", ie aged 1 to 5 days, despite the length of the period "symptom-balloon" about 3 hours.
Conclusions. We found a discrepancy between the histological and clinical age of coronary thrombi. It was also possible to confirm the existence of a connection between the structure of aspirated thrombi and the potential prognosis of acute myocardial infarction, including the development of complications in the long run.
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