Search Results (51)

Background: Coronary artery aneurysm and ectasia (CAAE) represent uncommon forms of coronary artery disease characterized by abnormal arterial dilatation and complex remodeling. The mechanisms underlying their development remain poorly defined. Optical coherence tomography (OCT) provides high-resolution evaluation of plaque morphology and vessel wall structure, offering insights into the pathophysiology of CAAE. Methods: We analyzed 21 patients with angiographically confirmed CAAE who underwent intracoronary OCT. Dilated segments were compared with adjacent non-dilated reference segments. Quantitative measurements included the maximal dilated segment’s diameter, reference diameter, and intima–media thickness. Qualitative assessment focused on plaque composition, calcification, neovascularization, fibrous cap characteristics, and thrombus. Results: Aneurysmal segments displayed larger lumen dimensions but no proportional increase in plaque burden, consistent with exaggerated positive remodeling. Compared with non-aneurysmal regions, CAAE segments exhibited significantly smaller calcification arcs and a lower prevalence of lipid plaques and neovascularization, suggesting a heterogeneous and potentially more fibrotic remodeling pattern. Classical features of plaque vulnerability were not consistently present in dilated segments, suggesting that hemodynamic factors, such as disturbed flow and stenosis, may contribute substantially to the thrombotic risk. Conclusions: OCT reveals distinct structural and compositional characteristics in CAAE, supporting the concept of maladaptive remodeling rather than uniformly unstable plaque. High-resolution intracoronary imaging enhances understanding of CAAE pathophysiology and may facilitate individualized clinical assessment and management. Full article

Objective: This study aimed to assess the association between the histopathological characteristics of thrombi extracted during endovascular thrombectomy and clinical factors, including the location of the occlusion, comorbid conditions, and treatment effectiveness, in patients with acute ischemic stroke. Materials and Methods: A total of 57 patients with acute ischemic stroke who underwent endovascular thrombectomy between 1 January 2022 and 31 December 2024 were included in the study. Thrombi were analyzed histopathologically and classified into categories based on their composition (RBC-dominant, fibrin-dominant, RBC = fibrin, organized fibrin) and phase (early or late stage). CD34 staining was used to assess organized fibrin. Results: The mean age of the patients was 65.2 ± 15.3 years, 52.6% were female, and 47.4% were male. The majority of thrombi were retrieved from the MCA M1 segment (64.9%). Histopathological analysis revealed that 49.1% of thrombi were RBC-dominant, 21.1% RBC = fibrin, 19.3% fibrin-dominant, and 10.5% contained organized fibrin. Early-stage thrombi accounted for 70.2% of cases, while late-stage thrombi comprised 29.8%. Thrombus composition was significantly associated with anatomical location, with RBC-dominant thrombi being most prevalent in the proximal ICA (88.2%; p < 0.001). CD34 staining identified organized fibrin in 10.5% of thrombi, exclusively in patients who underwent stent placement. However, no statistically significant correlation was identified between CD34 positivity and thrombus composition (p > 0.05). Additionally, no notable associations were found between thrombus composition and chronic comorbidities. Conclusions: Thrombus composition and stage exhibit variability depending on anatomical location, particularly in the proximal ICA, where RBC-dominant thrombi are more frequent. Although CD34 positivity indicates organized fibrin, it does not show a significant relationship with thrombus characteristics or patient comorbidities. These findings underscore the complex interplay between thrombus histopathology, anatomical location, and procedural outcomes, highlighting the need for further investigation. Full article

Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide, requiring rapid reperfusion to minimize damage. Current treatments, including intravenous thrombolysis (IVT) with alteplase (rt-PA) and mechanical thrombectomy (MT), face limitations such as thrombolysis resistance, dosing complexity, and reduced efficacy in large vessel occlusions (LVOs) or fibrin-rich clots. Tenecteplase (TNK), a bioengineered thrombolytic agent with superior pharmacokinetics, simplified administration, and higher fibrin specificity, offers promising advantages over rt-PA, including potential synergy with MT and efficacy against resistant thrombi. Direct oral anticoagulants (DOACs) further complicate AIS management, but evidence suggests that DOAC-treated patients may experience better thrombolysis outcomes due to distinct thrombus characteristics. Advances in imaging now enable precise visualization of vessel occlusion and treatment effects, opening opportunities to refine therapies. Combination approaches targeting fibrin thrombus components may enhance thrombolysis and improve outcomes in resistant cases. Future research should explore TNK’s role in intra-arterial (IA) applications, combination therapies, and its interaction with MT to optimize reperfusion strategies. TNK’s simplified use and promising efficacy position it as a potential breakthrough in AIS management, with the potential to improve functional recovery and reduce treatment complexity. Full article

The use of imaging during percutaneous coronary intervention (PCI) can improve the outcomes by giving key information in every phase of the procedure. It can improve the knowledge of plaque composition thus helping the subsequent technical strategy; it can precisely define the measure of the stent to implant; it can assess in detail the correct positioning of the stent (apposition, expansion, and full coverage of the atherosclerotic plaque); it helps in recognizing the complications that may occur after stenting (e.g., edge dissection or tissue/thrombus protrusion in the stent area). Further, it could help evaluation for both diagnostic and therapeutic purposes of angiographic unknown or questionable findings [e.g., spontaneous coronary artery dissection (SCAD), characterization of mycotic aneurysm and pseudoaneurysm]. In the follow up phase, the use of intracoronary imaging may significantly improve the understanding of the mechanisms leading to the procedural failure. What this review adds is to describe the similarities and differences between intravascular ultrasound (IVUS) and optical coherence tomography (OCT) technologies, to highlight the evidence supporting their utility to improve PCI outcomes, to give practical advice and tools on daily interventional routine, to show a point of view on future perspectives and integration with artificial intelligence (AI). Full article

Introduction: We aimed to clarify the influence of the thrombus composition on ischemic stroke endovascular thrombectomy (EVT) efficiency by utilizing various staining methods for patients that presented with occlusions of the middle cerebral artery (MCA). Methods: Between September 2017 and May 2021, we analyzed thrombi retrieved during endovascular thrombectomy EVT in patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusion. Patients with reperfusion failure, intracranial atherosclerotic occlusions, and inadequate staining were excluded. The thrombus composition was stratified using three staining techniques—Hematoxylin and Eosin (H&E), Martius Scarlet Blue (MSB) staining, and immunohistochemistry (IHC) for red blood cells (RBCs), white blood cells (WBCs), fibrin (Fibrin II), and platelets (CD41). Associations between EVT efficiency outcomes and the thrombus composition were evaluated. Results: During the study period, thrombus was available for analysis in 159 patients. A total of 59 patients were included in the main analysis. Increases in the trichotomized RBS tertiles were associated with decreases in the components of various platelet/other components but not for fibrin. A modified first pass effect (mFPE) of the modified Thrombolysis in Cerebral Infarction perfusion scale (mTICI) 2b or higher was associated with larger thrombus surface area (16.0 ± 11.6 vs. 47.4 ± 62.3 mm², p = 0.005), a higher MSB fibrin content (29.8 ± 10.7 vs. 21.3 ± 10.9%, p = 0.002), and IHC fibrin (28.5 ± 14.5 vs. 20.1 ± 11.4%, p = 0.008). There was a marginal association between the mTICI 2b mFPE and lower MSB platelet/other components (27.6 ± 20.9 vs. 34.4 ± 14.9%, p = 0.078). The discrepancy between MSB platelet/others and IHC platelets was greater in the mFPE (-) group, suggesting that components other than platelets may contribute to EVT resistance. A mFPE of mTICI 2c or higher was associated with greater thrombus surface area (17.8 ± 11.9 vs. 37.7 ± 55.0 mm², p = 0.015) and MSB fibrin (32.1 ± 10.3 vs. 22.8 ± 11.0%, p = 0.002). There was a marginal reverse association between the mTICI 2c mFPE and MSB RBCs (33.4 ± 20.2% vs. 41.5 ± 17.3%, p = 0.062). There was no significant association between final near-complete reperfusion and the thrombus composition. Conclusions: In patients presenting with occlusions of the MCA, a higher thrombus fibrin content is associated with better EVT efficiency. Both a higher MSB platelet/other components and RBC content may have a negative influence on EVT efficiency. These results may help identify preprocedural biomarkers beyond the conventional assessment of RBCs, WBCs, and fibrin compositions, which could guide decision-making during mechanical thrombectomy. Full article

Background/Objectives: The D-dimer/fibrinogen ratio (D-d/F) has been proposed as a composite marker of fibrinolysis–coagulation balance. Whether D-d/F reflects CT-quantified thrombus burden and right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) remains uncertain. Methods: Single-center retrospective cohort of consecutive adults with CTPA-confirmed PE (January 2022–October 2024). D-d/F = D-dimer (µg/mL)/fibrinogen (mg/dL). Thrombus burden: Qanadli and Mastora indices. RVD: RV/LV ratio, septal bowing, and IVC reflux. Associations: Spearman’s ρ with Steiger’s Z for between-marker comparisons. Discrimination for Qanadli ≥ 40% and RV/LV ≥ 1.0 by ROC. Two exploratory logistic models predicted Qanadli ≥ 40%: Model-1 (age, sex, D-d/F) and Model-2 adding RV/LV. Results: Among 112 patients (mean age 65.4 ± 15.6; 60% men), D-d/F correlated modestly with Qanadli (ρ = 0.233, p = 0.013) and Mastora (ρ = 0.274, p = 0.0034); strengths were similar to D-dimer (no between-marker difference: Steiger’s Z both p > 0.5). D-d/F correlated with RV/LV (ρ = 0.335, p < 0.001) and with IVC reflux (ρ = 0.247, p = 0.0085). CT indices related more strongly to hemodynamic markers (e.g., Qanadli with RV/LV ρ = 0.571, p < 0.0001; Mastora with RV/LV ρ = 0.620, p < 0.0001). Patients with septal bowing had higher D-dimer (median 4.65 vs. 2.74 µg/mL, p = 0.0037), higher D-d/F (1.04 vs. 0.61, p = 0.0018), and higher clot-burden scores (both p < 0.0001). For Qanadli ≥ 40%, AUCs were 0.621 for D-d/F (cut-off > 0.795; sens 58.8%, spec 62.3%) and 0.618 for D-dimer (>1.894 µg/mL; 84.3%, 37.7%); AUCs did not differ (p = 0.93). For RV/LV ≥ 1.0, AUCs were 0.693 for D-d/F (>0.607; 83.8%, 52.0%) and 0.684 for D-dimer (>2.849 µg/mL; 75.7%, 54.7%); p = 0.72. In Model-1, D-d/F predicted Qanadli ≥ 40% (OR = 1.43 per unit, p = 0.043; AUC = 0.64). After adding RV/LV (Model-2), discrimination improved (AUC = 0.796), RV/LV remained a strong predictor (p < 0.0001), and D-d/F was not retained (p = 0.287). Conclusions: In acute PE, D-d/F tracks thrombus burden and RVD to a degree comparable to D-dimer, but effects are modest. CT-based markers—particularly RV/LV—better reflect disease severity and are more predictive of high clot burden. Risk prediction and incremental utility of D-d/F were not assessed and warrant prospective evaluation. Full article

Background: Patients with atrial fibrillation (AF) who have a high bleeding risk or contraindications to anticoagulation may be candidates for left atrial appendage closure (LAAC). However, the presence of a thrombus in the left atrial appendage (LAA) is generally considered a contraindication to the procedure. While the feasibility and short-term safety of LAAC in patients with pre-existing LAA thrombus has been reported, data on long-term outcomes remain limited. Objective: To assess the long-term clinical outcomes of AF patients undergoing LAAC in the presence of an LAA thrombus. Methods: This retrospective, single-center registry included all AF patients who underwent LAAC between June 2010 and April 2024. Patients were stratified based on the presence or absence of LAA thrombus at the time of the procedure. The primary endpoint was a 5-year composite of stroke, systemic embolism, or all-cause mortality. Results: A total of 403 patients underwent LAAC, of whom 24 (6%) had an LAA thrombus at the time of the procedure. During a median follow-up of 3.9 years, the primary endpoint occurred in 116 patients: 110 events (41%) in the no-thrombus group and 6 events (38%) in the thrombus group. There was no statistically significant difference in major adverse cardiovascular events (MACE) between groups (log-rank p = 0.862). Conclusions: LAAC may be performed safely in selected patients with distal LAA thrombus, with long-term outcomes comparable to those without thrombus. Full article

Background: Left ventricular thrombus (LVT) remains a well-recognized complication following myocardial infarction (MI). Whilst vitamin K antagonists (VKAs) have traditionally been the cornerstone of management, direct oral anticoagulants (DOACs) have been increasingly utilized despite limited data to support this. We sought to perform an up-to-date meta-analysis of all randomized controlled trials (RCTs) comparing DOACs to VKAs for LVT resolution. Methods: A systematic search of major scientific databases was performed to identify RCTs published until May 2025. The primary efficacy endpoint was complete LVT resolution at 3 months. The risk ratio (RR) and 95% confidence intervals (CIs) of the individual RCTs were pooled via the inverse-variance method and random-effects model. Results: Seven RCTs involving 554 patients with a mean age of 54 years were included in the meta-analysis. At 3 months, there was no difference in the rate of LVT resolution between those in the DOAC arm and the warfarin arm (86% vs. 81%, RR 1.01 [95%CI 0.93–1.10], p = 0.76). There was low heterogeneity at I² = 15%. There was no difference in major or clinically significant bleeding or in the composite of stroke or thromboembolic complications, although the 95%CIs were wide. Conclusions: DOACs appear to be comparable to warfarin in achieving LVT resolution at 3 months. These findings support the consideration of DOACs as alternatives to VKAs in selected patients for LVT resolution. Further adequately powered trials and head-to-head comparisons between DOACs are required to confirm their safety. Full article

Background and Clinical Significance: Bladder neoplasms often present with coexisting thrombi and hematuria, appearing as complex intraluminal masses on imaging, and posing a key diagnostic challenge in distinguishing neoplastic tissue from thrombus, to prevent harmful overstaging. Case Presentation: An 82-year-old man with recurrent gross hematuria and urinary disturbances was evaluated by ultrasound, which identified a large endoluminal lesion in the anterior bladder wall. The patient subsequently underwent contrast-enhanced CT using a second-generation dual-layer spectral CT system, which utilizes a dual-layer detector to simultaneously acquire high- and low-energy X-ray data. Conventional CT images confirmed a multifocal, bulky hyperdense lesion along the bladder wall, protruding into the lumen and raising suspicion for a heterogeneous mass, though further characterization was not possible. Spectral imaging enabled the reconstruction of additional maps—such as iodine density, effective atomic number (Z-effective), and electron density—which were used to further characterize these findings. The combination of these techniques clearly demonstrated differences in iodine uptake and tissue composition within the parietal lesions, allowing for a reliable differentiation between neoplastic tissue and intraluminal thrombus. Conclusions: The integration of conventional CT imaging with spectral-derived maps generated in post-processing allowed for accurate and reliable tissue differentiation between bladder neoplasm and thrombus. Spectral imaging holds the potential to prevent tumor overstaging, thereby supporting more appropriate clinical management. The dual-layer technology enables the generation of these maps from every acquisition without altering the scan protocol, thereby having minimal impact on the daily clinical workflow. Full article

Background: The mechanisms underlying fibrinolysis failure in patients with STEMI who are undergoing a pharmacoinvasive strategy appear to be multifactorial and may be associated with the thrombus’s architecture and composition. Objective: We aimed to compare the thrombus composition in patients with STEMI who were undergoing rescue percutaneous coronary intervention (rPCI) versus primary PCI (pPCI) using optical microscopy (OM) and scanning electron microscopy (SEM). Methods: Fifty-three patients were prospectively enrolled, with twenty-five undergoing rPCI and twenty-eight undergoing pPCI. After thrombus aspiration, each harvested fragment was divided into two pieces: one was analyzed using OM with a 60× magnifying lens on hematoxylin–eosin-stained samples, and the other with SEM at 5000× magnification. Results: Patients who underwent rPCI had significantly higher C-reactive protein levels and a longer ischemic interval at admission compared to those treated with pPCI (9.92 h [range: 1.58–106.17] vs. 2.14 h [range: 0–48]; p < 0.001). Optical microscopy analysis revealed that thrombi from rPCI patients exhibited a significantly higher erythrocyte area percentage (18.36% [range: 0.3–50.08] vs. 0.91% [range: 0–70.1]; p = 0.001), a lower fibrin content as assessed by optical microscopy (79.49% [range: 49.2–98.25] vs. 94.43% [range: 29.19–99.92]; p = 0.006), and a greater amount of cholesterol crystals as measured by SEM (1.73 μm² [range: 0–18.51] vs. 0.08 μm² [range: 0–0.71]; p < 0.001). Conclusions: The thrombus composition of patients with STEMI who are undergoing rPCI had higher amounts of erythrocytes and cholesterol crystals and a lesser area occupied by fibrin compared to those undergoing pPCI. The composition of thrombi in rPCI could potentially contribute to the failure of fibrinolytic therapy within a pharmacoinvasive strategy. Full article

Knowing the precise etiology in ischemic stroke is necessary to ensure accurate diagnosis and decide on appropriate preventive treatments, especially in those of undetermined cause. Analysis of the thrombus protein composition could be useful to identify diagnostic biomarkers to help determine the stroke origin. Thrombi from 54 ischemic stroke patients with large vessel occlusion (LVO), of cardioembolic and atherothrombotic etiology, were analyzed using a proteomics approach. The proteome profile was compared between them to detect differential proteins of each etiology. Peptides of those differential proteins were quantified and related to the neurological function and clinical status of the patients. Of the 516 proteins identified, three showed significant differences between atherothrombotic and cardioembolic thrombi. These were fibronectin (FINC), 2,3-bisphosphoglycerate mutase (PMGE), and tropomyosin-1 (TPM1). Combining these proteins in a biomarker panel provided good sensitivity and high specificity for differentiating cardioembolic and atherothrombotic strokes. In addition, several of the quantified peptide levels correlated with clinical parameters related to stroke severity and prognosis. Three proteins differentially detected in ischemic stroke thrombi could be useful tools for accurately diagnosing ischemic stroke etiology, particularly in cases of undetermined cause. These biomarkers should be further analyzed in prospective multicenter studies to demonstrate their usefulness. Full article

Background: Large vessel occlusion (LVO) strokes account for a significant proportion of ischemic strokes and are often cardioembolic in origin, particularly following atrial fibrillation (AF) with thrombus formation in the left atrial appendage (LAA). Although direct oral anticoagulation (DOAC) therapy reduces stroke risk in AF, anatomical and flow-related factors may still allow thrombi to form and persist, revealing the limitations of anticoagulation in high-risk patients. Examining structural and hemodynamic factors contributing to thrombus persistence is essential for optimizing patient management. Methods: We retrospectively analyzed 169 AF patients with LVO stroke who underwent cardiac CT (cCT) during acute stroke assessment. Patients were categorized based on the presence or absence of persistent LAA thrombi and further stratified by DOAC status. LAA volume, blood stasis and left ventricular (LV) diameter were measured. Thrombi were assessed using Hounsfield Unit (HU) analysis to evaluate potential differences in thrombus composition. Logistic regression analysis was performed to identify independent predictors of thrombus persistence with adjustment for DOAC therapy. Results: Persistent LAA thrombi were identified in 23 patients (13.6%). Patients with thrombi had significantly higher rates of stasis (p = 0.004), larger left ventricular diameters (p = 0.0019) and higher LAA volumes (p = 0.004). When adjusted for DOAC therapy, larger LAA volume (OR 1.05, p = 0.011), presence of LAA stasis (OR 6.14, p = 0.013) and increased LV diameter (OR 1.06, p = 0.006) were independent predictors of thrombus persistence. Thrombus size and HU values did not differ significantly between DOAC and non-DOAC groups. Notably, 30.4% of patients with persistent thrombi were on adequate DOAC therapy. Conclusions: LAA volume, stasis and LV enlargement predict thrombus persistence in the LAA of AF patients with LVO stroke, even under adequate DOAC therapy. These findings highlight the potential need for alternative antithrombotic strategies, including interventional LAA occlusion, and warrant further investigation into individualized stroke prevention in high-risk AF populations. Full article

Background/Objectives: The composition of the thrombus is not taken into account in the etiology determination of patients with acute ischemic stroke (AIS); however, it varies depending on the origin of the thrombus, as atherothrombotic thrombi contain more red blood cells and cardioembolic thrombi contain more fibrin and platelets. Radiomics has the potential to provide quantitative imaging data that may vary depending on the composition of thrombi. The aim of this study is to predict cardioembolic and atherothrombotic thrombi using radiomic features (RFs) from non-contrast computed tomography (NCCT) brain scans. Methods: A total of 845 RFs were extracted from each of the 41 patients included in the study. A predictive model was used to classify patients as either cardioembolic or atherothrombotic, and the results were compared with the TOAST criteria-based classification. Results: Ten RFs (one shape feature and nine texture features) were found to demonstrate a statistically significant correlation with cardioembolic or atherothrombotic origins. The predictive radiomics model achieved an area under the curve (AUC) of 0.842 and an accuracy of 0.902 (p < 0.001) in classifying stroke etiology. Conclusions: Radiomics based on NCCT can help to determine the etiology of AIS. Full article

Extracorporeal membrane oxygenation (ECMO) is a crucial life support therapy for patients with severe cardiac and respiratory failure. However, the complications associated with venoarterial ECMO (VA-ECMO), including thrombus formation, bleeding, and hemolysis, remain significant challenges that impact patient outcomes and healthcare costs. These complications primarily arise from blood–material interactions within the ECMO circuit, necessitating the development of biocompatible materials to optimize hemocompatibility. This review provides an updated overview of the latest advancements in VA-ECMO materials, focusing on cannula, oxygenators, and centrifugal pumps. Various surface modifications, such as heparin coatings, nitric oxide-releasing polymers, phosphorylcholine (PC)-based coatings, and emerging omniphobic surfaces, have been explored to mitigate thrombosis and bleeding risks. Additionally, novel oxygenator membrane technologies, including zwitterionic polymers and endothelial-mimicking coatings, offer promising strategies to enhance biocompatibility and reduce inflammatory responses. In centrifugal pumps, magnetic levitation systems and hybrid polymer-composite impellers have been introduced to minimize shear stress and thrombogenicity. Despite these advancements, no single material has fully addressed all complications, and further research is needed to refine surface engineering strategies. This review highlights the current progress in ECMO biomaterials and discusses future directions in developing more effective and durable solutions to improve patient safety and clinical outcomes. Full article

Acute ischemic stroke (AIS) remains a critical concern in clinical practice, with significant implications for patient outcomes and healthcare costs. This review highlights the role of clot composition in AIS, emphasizing the clinical relevance of radiological characterization. Variations in thrombus composition, such as red blood cell (RBC)-rich and white blood cell (WBC)-dominant clots, influence the success of thrombolytic therapies and mechanical thrombectomy. Advanced radiological techniques, including non-contrast CT, CT angiography, and MRI, are essential for pre-interventional clot characterization, guiding optimal treatment decisions. Integrating artificial intelligence (AI) in radiology can enhance the precision of clot composition assessment, facilitating personalized treatment approaches and improving predictive accuracy. By combining histopathological insights with imaging and AI technologies, this review underscores the importance of comprehensive radiological evaluation in the management of AIS, ultimately aiming to enhance clinical outcomes and reduce the burden on healthcare systems. Full article