Cardiovascular Thrombus

Opis

Cardiovascular Thrombus: From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions provides a comprehensive, up-to-date presentation of the research and clinical practices as related to the contemporary aspects of the diagnosis and management of cardiovascular thrombosis. The formation, identification and management of cardiovascular thrombus is of paramount importance for researchers and practicing physicians, yet it remains one of the most challenging diagnostic and clinical scenarios. This important reference connects between research, up-to-date clinical knowledge, and the technological tools available for diagnosis and management of thrombus in cardiovascular medicine. The book includes comprehensive descriptions and review of pathology, clinical presentations, diagnosis, pharmacotherapy, interventions and future trends. It is the perfect reference for basic science students and researchers in general and interventional cardiology, general and interventional radiology, vascular medicine specialists, and vascular, general and cardiac surgeons.

Provides comprehensive presentation of the pathophysiology, clinical presentations and diagnosis of cardiovascular thrombosis
Includes the most up-to-date information on the practical management of patients with thrombus related conditions
Written by the leading experts in the field
Describes the current and upcoming pharmacotherapy and technology available for thrombus research and treatment

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Front Cover 2
Cardiovascular Thrombus 3
Cardiovascular Thrombus 5
Copyright 6
Dedication 7
Contents 9
List of Contributors 21
Foreword 29
Preface 31
1 - Histopathology of Cardiovascular Thrombus 33
- PREVALENCE OF HEART DISEASE 33
- CORONARY THROMBOSIS: INCIDENCE AND ETIOLOGY 33
  - Plaque Rupture 34
- NECROTIC CORE EXPANSION (PLAQUE FISSURE AND INTRAPLAQUE HEMORRHAGE) 37
  - Erosion 38

Front Cover 2
Cardiovascular Thrombus 3
Cardiovascular Thrombus 5
Copyright 6
Dedication 7
Contents 9
List of Contributors 21
Foreword 29
Preface 31
1 - Histopathology of Cardiovascular Thrombus 33
- PREVALENCE OF HEART DISEASE 33
- CORONARY THROMBOSIS: INCIDENCE AND ETIOLOGY 33
  - Plaque Rupture 34
- NECROTIC CORE EXPANSION (PLAQUE FISSURE AND INTRAPLAQUE HEMORRHAGE) 37
  - Erosion 38
  - Calcified Nodule 40
  - Healed Plaque Rupture 40
- REFERENCES 43
- CONCLUSION 43
2 - Pathology of Arterial Thrombosis: Characteristics and Thrombus Types 47
- ATHEROSCLEROSIS 47
- INTRODUCTION 47
- TYPES OF THROMBI DURING ACUTE MYOCARDIAL INFARCTION 48
- METHODS TO DETECT THROMBI 50
- RISK FACTORS FOR ARTERIAL AND VENOUS THROMBOSIS 51
- ATHEROSCLEROSIS, INFLAMMATION, AND THROMBOSIS 52
- TREATMENT OF ATHERO-CRYSTALLOIDS 56
- CLOT RETRACTION AND FIBRINOLYSIS 58
- TREATMENT OF ARTERIAL THROMBOSIS 58
- FIBRINOLYSIS 58
- REFERENCES 59
3 - Fibrin Clot Structure and Function: A Novel Risk Factor for Arterial and Venous Thrombosis and Thromboembolism 63
- INTRODUCTION 63
- FIBRIN AND CLOT FORMATION 65
- FACTOR XIII 66
- FIBRINOLYSIS 67
- CLOT MECHANICS 68
- ALTERNATIVE MRNA FIBRINOGEN SPLICING 69
- FIBRIN CLOT STRUCTURE AND CORONARY ARTERY DISEASE 70
- FIBRIN CLOT STRUCTURE AND VENOUS THROMBOSIS 71
- ROLE OF SMOKING, DIABETES, AND GLYCATION 72
- STROKE, PERIPHERAL DISEASE, AND ANEURYSM 72
- MEDICATION AND CLOT STRUCTURE 73
- CONCLUSIONS 75
- REFERENCES 75
4 - The Role of Platelets in the Pathophysiology of Atherosclerosis and Its Complications 83
- PLATELETS 83
- PLATELET ACTIVATION AND FUNCTION 84
  - Thrombin 84
  - Thromboxane A2 85
  - Adenosine Diphosphate 85
- MONOCYTES 86
  - The Role of Monocytes in Atherosclerosis 86
  - Monocyte Phenotypes and Their Differential Contribution to Atherosclerosis 87
  - Monocyte-Platelet Interactions 88
- PLATELETS AS MODULATORS OF INFLAMMATION: RELEVANCE TO ATHEROSCLEROSIS 86
- THE ROLE OF INFLAMMATION IN ATHEROSCLEROSIS 86
- NETRIN-1 89
  - Netrin-1 in Atherosclerosis 90
  - Antiplatelet Therapy and Netrin-1 91
  - The Relationship Between Netrin-1 and Inflammation 91
- POLYMORPH-PLATELET INTERACTIONS 89
- ANTIPLATELET THERAPY AS A POSSIBLE NOVEL APPROACH TO INHIBITING ATHEROSCLEROSIS 91
- CONCLUSIONS 93
- REFERENCES 93
5 - Mathematical Models of Thrombus Formation and Fibrinolysis 99
- INTRODUCTION 99
- OVERVIEW OF DIFFERENTIAL EQUATIONS 99
- BRIEF BIOLOGICAL BACKGROUND 100
  - Coagulation and Platelet Aggregation 100
    - Fibrinolysis 102
    - Fibrin Polymerization 102
  - MODELS OF THROMBIN GENERATION AND THROMBUS FORMATION 103
    - Zero-Dimensional Models 103
    - Coagulation Under Flow: Zero-Dimensional Models 104
      - Coagulation and Biophysical Factors: Two- and Three-Dimensional Models 106
    - Blood as an Excitable Medium 106
    - Size Thresholds 108
    - Advection-Reaction-Diffusion Models and Spatial Heterogeneity 108
  - MODELS OF FIBRIN POLYMERIZATION 111
  - MODELS OF FIBRINOLYSIS 111
  - ACKNOWLEDGMENTS 114
  - REFERENCES 114
  - SUMMARY 114
- 6 - Animal Models of Thrombosis 119
  - BRIEF OVERVIEW OF THE PATHOGENESIS OF THE THROMBOTIC PROCESS 119
  - DEVELOPMENT OF ANIMAL MODELS OF THROMBOSIS 119
  - SMALL ANIMAL MODELS OF THROMBOSIS: THE MURINE MODELS 120
  - LARGE ANIMAL MODELS OF THROMBOSIS 122
    - Nonhuman Primates, Pigs, and Equines 122
    - Canine Models of Thrombosis 122
  - ARTERIOVENOUS SHUNT AND PERFUSION CHAMBERS: IN VIVO/EX VIVO MODELS OF THROMBOSIS IN LARGE ANIMAL MODELS 123
  - ANIMAL MODELS OF VENOUS THROMBOSIS 123
  - OTHER MODELS OF THROMBOSIS 124
    - Animal Models of Intracranial Thrombosis 124
    - Von Willebrand Disease in Large Animal Models 124
  - CONCLUSIONS AND FUTURE CHALLENGES 125
  - REFERENCES 126
  - ACKNOWLEDGMENTS 126
- 7 - Imaging Modalities for Detection and Treatment of Cardiovascular Thrombus 131
  - THROMBUS-CONTAINING LESION IN THE CORONARY CIRCULATION 131
    - Intravascular Ultrasound 132
    - Coronary Angiography 132
    - Optical Coherence Tomography 133
    - Cardiac/Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance Imaging 134
  - INTRODUCTION 131
  - NONCORONARY THROMBUS 135
    - Left-Atrial Thrombus 135
    - Left-Ventricular Thrombus 138
    - Right-Heart Thrombus 140
    - Heart Valve Thrombus 140
  - REFERENCES 142
- 8 - Utilization of Magnetic Resonance Imaging and Magnetic Resonance Angiography for Cardiac Thrombus 147
  - TECHNIQUE AND IMAGE ACQUISITION 147
  - INTRODUCTION 147
  - CARDIOMYOPATHY AND LEFT-VENTRICULAR THROMBUS 148
  - CARDIAC MAGNETIC RESONANCE CHARACTERISTICS OF THROMBUS 150
  - ATRIAL FIBRILLATION 152
  - REFERENCES 153
  - CONCLUSION 153
- 9 - Acute Myocardial Infarction: STEMI and NSTEMI 155
  - INTRODUCTION 155
    - Pathophysiological Importance of Intracoronary Thrombus in Acute Myocardial Infarction 155
  - ANTIPLATELET THERAPY IN ACUTE CORONARY SYNDROME 156
    - Clopidogrel 156
    - Aspirin 156
    - Prasugrel 157
    - Ticagrelor 158
    - Intravenous P2Y12 Inhibitors 158
    - Intravenous Glycoprotein IIb/IIIa Inhibitors 160
  - ANTICOAGULATION 160
  - FACTOR XA AND THROMBIN INHIBITORS IN ACUTE CORONARY SYNDROMES 162
    - Mechanical Methods of Thrombus Reduction 163
    - Thrombus Aspiration Technology 163
    - Clinical Trial Data of Thrombectomy in Myocardial Infarction 165
    - Excimer Laser Coronary Atherectomy 170
  - REFERENCES 173
  - CONCLUSIONS 173
- 10 - Acute Coronary Syndrome: Thrombotic Lesions in Patients With Unstable Angina 179
  - UNSTABLE ANGINA 179
    - Definition 179
    - Epidemiology 179
  - PATHOLOGY AND PATHOPHYSIOLOGY OF THE THROMBOTIC LESION 180
    - Thrombosis 180
    - Inflammation 181
    - Proteolysis 182
  - VULNERABLE PLAQUE 182
  - CLINICAL PRESENTATION 183
  - NONINVASIVE DIAGNOSIS 184
    - Electrocardiogram 184
    - Biomarkers/Laboratory Testing 184
    - Noninvasive Imaging 185
  - INVASIVE DIAGNOSIS 185
    - Coronary Angiography 186
    - Fractional Flow Reserve 186
    - Intravascular Ultrasound, Optical Coherence Tomography, and Coronary Angioscopy 186
  - TREATMENT 187
    - Antiplatelet Agents 187
    - Medical Therapy 187
    - Antithrombotic Agents 187
    - Revascularization 188
  - LONG-TERM THERAPY AND OUTCOMES 188
  - SUMMARY 188
  - REFERENCES 190
- 11 - Practical Perspectives on the Guidelines for Management of Coronary Thrombus 195
  - INTRODUCTION 195
  - PROGNOSTIC SIGNIFICANCE OF THROMBUS 195
  - MANAGEMENT OF HIGH THROMBUS BURDEN 196
  - PHARMACOLOGICAL STRATEGIES FOR INTRACORONARY THROMBUS 196
    - Local Thrombolysis 197
    - Novel Therapies 197
  - MECHANICAL STRATEGIES 198
    - Thrombectomy Devices 198
    - Distal Protection Devices 199
    - Stent Choice for Thrombotic Conditions 201
    - Excimer Laser 201
    - The Deferred Stenting Management Strategy 202
  - APPROACHES IN EXCEPTION TO THE CURRENT GUIDELINES 202
  - EXPERT OPINION 202
  - SUMMARY 203
  - REFERENCES 204
- 12 - Thrombus Classifications: Critical Tools for Diagnostic and Interventional Cardiovascular Procedures 207
  - RATIONALE FOR UTILIZATION OF THROMBUS CLASSIFICATIONS 207
  - INTRODUCTION 207
  - THROMBUS: FROM FORMATION TO ACCUMULATION 208
  - SCORING SYSTEMS FOR CORONARY THROMBUS 209
  - THE ``ANGRY THROMBUS'' PHENOMENON 215
  - THROMBUS SCORING IN NONCORONARY VASCULATURE 215
  - THROMBUS GRADING IN PERIPHERAL ARTERIAL DISEASE 217
  - SUMMARY 217
  - REFERENCES 217
- 13 - Impact of Thrombus Burden on Myocardial Damage in the Setting of Primary Percutaneous Coronary Intervention 221
  - THE ROLE OF THROMBUS IN THE PATHOPHYSIOLOGY OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION 221
  - THROMBUS RECOGNITION AND CLASSIFICATIONS 222
  - RELATIONSHIP BETWEEN THROMBUS BURDEN AND DISTAL EMBOLIZATION 223
  - IMPACT OF DISTAL EMBOLIZATION ON MYOCARDIAL DAMAGE AND CLINICAL OUTCOMES 226
  - ROLE OF MECHANICAL ADJUNCTIVE DEVICES IN THROMBUS REMOVAL AND MYOCARDIAL DAMAGE 229
  - REFERENCES 230
- 14 - The Impact of Thrombus as a Cause and as a Result of Complicated Percutaneous Coronary Intervention 235
  - INTRODUCTION 235
  - THROMBUS AS THE CAUSE OF COMPLICATIONS 235
    - Wiring Through the Thrombotic Occlusion: Risk of Perforation 235
    - Restoring Antegrade Flow (Fig. 14.2) 236
    - Thrombectomy for Primary Percutaneous Coronary Intervention: Clinical Trials and Guidelines 239
    - Preventing Embolization 239
  - THROMBUS AS THE RESULT OF COMPLICATED PERCUTANEOUS CORONARY INTERVENTION 241
    - Suboptimal Antithrombotic Treatment 241
    - Thrombus Embolization From the Sheath or Guide Catheter 241
    - Complications Causing Decreased Coronary Flow 244
  - CONCLUSIONS 246
  - DISCLOSURES 246
  - REFERENCES 246
- 15 - Stent Thrombosis: Early, Late, and Very Late 249
  - DEFINITION OF STENT THROMBOSIS 249
  - INCIDENCE OF STENT THROMBOSIS 249
  - CLINICAL PRESENTATION, DIAGNOSIS, AND MORTALITY 250
  - PATHOPHYSIOLOGIC MECHANISMS OF STENT THROMBOSIS 251
  - PHARMACOTHERAPY 252
  - INTRAVASCULAR IMAGING: IDENTIFICATION OF POTENTIAL MECHANISMS/STENT OPTIMIZATION 253
  - REFERENCES 254
  - CONCLUSION 254
- 16 - Stent Thrombosis: Implications for New Stent Designs and Dual Antiplatelet Therapy Duration 257
  - INTRODUCTION 257
  - BARE METAL STENTS VERSUS DRUG-ELUTING STENTS 260
  - DRUG-ELUTING STENTS VERSUS DRUG-ELUTING STENTS 260
  - BIO-RESORBABLE VASCULAR SCAFFOLD THROMBOSIS 262
  - DUAL ANTIPLATELET THERAPY 262
  - FACTORS INFLUENCING OPTIMAL DUAL ANTIPLATELET THERAPY DURATION 267
  - BARE METAL STENTS 267
  - RISK-PREDICTIVE MODELS 268
    - Dual Antiplatelet Therapy Risk Score 268
    - Paris Risk Score 271
    - PRECISE-DAPT Score 271
  - DUAL ANTIPLATELET THERAPY INTERRUPTION/DISCONTINUATION 273
  - STOPPING DUAL ANTIPLATELET THERAPY FOR NONCARDIAC SURGERY 274
  - REFERENCES 275
- 17 - Aspiration Catheters and Protection Filters 281
  - INTRODUCTION 281
  - ASPIRATION THROMBECTOMY 281
    - Percutaneous Aspiration Thrombectomy Catheter System 281
    - Use of Aspiration Catheters in STEMI Patients 282
    - Thrombus Aspiration in Patients With Non-STEMI 284
    - Risks Associated With Aspiration Thrombectomy 284
    - Reasons for the Lack of Improvement in Clinical Outcomes 284
  - EMBOLIC PROTECTION DEVICES 286
    - Proximal Occlusion Aspiration Catheters 286
    - Distal Embolic Filter Devices 287
    - Distal Occlusion Aspiration Devices 288
    - Clinical Evidence Behind Embolic Protection Devices 288
  - SUMMARY 290
  - REFERENCES 290
  - FURTHER READING 292
- 18 - Power-Sourced Mechanical Thrombectomy in the Management of Thrombus-Containing Atherosclerotic Lesions 293
  - INTRODUCTION 293
  - THROMBUS AS A DYNAMIC VASCULAR STRUCTURE 293
  - POWER-SOURCED THROMBECTOMY TOOLS: RATIONALE FOR UTILIZATION 294
  - LASERS 296
    - Laser-Tissue Interactions and Effects Pertinent to Thrombus Removal 298
    - Laser in Acute Myocardial Infarction 301
    - Unique Thrombotic Lesions Treated With Laser 302
      - Stent Thrombosis 302
      - Stent Restenosis 302
      - Saphenous Vein Bypass Graft Lesions 303
    - RHEOLYTIC THROMBECTOMY 304
    - X-SIZER THROMBECTOMY SYSTEM 308
    - ULTRASOUND 312
    - SUMMARY 312
    - REFERENCES 312
  - 19 - Dedicated Thrombus-Containing Stent Platforms 317
    - INTRODUCTION 317
    - STUDIES EVALUATING THE MGUARD STENT 318
      - MGuard in ST-Segment Elevation Myocardial Infarction 318
        
        Nonrandomized Trials 318
        
        Randomized Trials 319
        
        Real-World Experience 324
      - MGuard for Revascularization of Saphenous Vein Grafts 324
      - STENTYS STENT: DESIGN AND TECHNICAL CHARACTERISTICS 325
        
        STENTYS in ST-Segment Elevation Myocardial Infarction 326
        
        STENTYS for Revascularization of Saphenous Vein Grafts 329
      - MGuard in Other Coronary Pathologies 325
        
        Coronary Perforation 325
        
        Coronary Aneurysm 325
      - SELF-EXPANDING AND SELF-APPOSING STENTS: RATIONALE 325
      - CONCLUSIONS AND RECOMMENDATIONS 329
      - REFERENCES 331
    - MESH-COVERED STENTS: RATIONALE AND TECHNICAL CHARACTERISTICS 318
    - 20 - Dissolution of Thrombus With Ultrasound: A Journey Through Physics, Basic Research, and Clinical Utilization 335
      - INTRODUCTION 335
      - INHERENT SELECTIVITY 335
      - FIRST-GENERATION DEVICE 336
      - SECOND-GENERATION DEVICE 337
      - FUTURE DIRECTIONS: NONINVASIVE ULTRASOUND THROMBOLYSIS 341
      - REFLECTIONS 342
      - REFERENCES 342
    - 21 - The Role and Impact of Thrombus in Formation and Revascularization of Chronic Total Occlusions 343
      - FORMATION OF CHRONIC TOTAL OCCLUSION 343
      - STRUCTURAL FEATURES OF CHRONIC TOTAL OCCLUSION 344
      - CLINICAL ASPECTS 345
      - PERCUTANEOUS REVASCULARIZATION 346
      - DEDICATED THROMBUS PHARMACOTHERAPY IN CHRONIC TOTAL OCCLUSION 346
      - REVASCULARIZATION TOOLS FOR CHRONIC TOTAL OCCLUSION 347
        
        AngioJet 347
        
        Excimer Laser 347
        
        Stents 348
      - CHRONIC TOTAL OCCLUSION IN PERIPHERAL ARTERIAL DISEASE 349

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From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions

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