Academic literature on the topic 'Thrombus fragmentation'
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Journal articles on the topic "Thrombus fragmentation"
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Fregona, Virginia, GIULIA LURAGHI, Behrooz Fereidoonnezhad, et al. "Impact of thrombus composition on virtual thrombectomy procedures using human clot analogues mechanical data." Journal of the Mechanical Behavior of Biomedical Materials 163 (January 2, 2025): 106886. https://doi.org/10.1016/j.jmbbm.2025.106886.
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Endovascular thrombectomy (EVT) aims at restoring blood flow in case of acute ischemic stroke by removing the thrombus occluding a large cerebral artery. During the procedure with stent-retriever, the thrombus is captured within the device, which is then retrieved, subjecting the thrombus to several forces, potentially leading to its fragmentation. In silico studies, along with mechanical characterisation of thrombi, can enhance our understanding of the EVT, helping the development of new devices and interventional strategies. Our group previously validated a numerical approach to study EVT able to account for thrombus fragmentation. In this study, the same methodology was employed to explore the applicability of the chosen failure criterion to EVT simulations and the impact of thrombus composition on the outcome of the in silico procedure. For the first time, human clot analogues experimental data were applied to this methodology. Clot analogues of three different compositions were tested, and a material model incorporating failure was calibrated, followed by a verification analysis. Finally, the calibrated material model was used to perform EVT simulations, combining the three tested thrombus compositions with three different stent retriever models. The experimental tests confirmed a compression-tension asymmetry in the stress-strain curves, showing decreasing stiffness with increasing the red blood cell (RBC) content. Applying the resulting material models to EVT simulations demonstrated: (i) the dependency of the failure criterion on the thrombus mesh size, (ii) a greater tendency for RBC-rich thrombi to fragment, and (iii) increased difficulty in retrieving RBC-poor thrombi compared to RBC-rich thrombi.
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Ohara, Tomoyuki, Bijoy K. Menon, Fahad S. Al-Ajlan, et al. "Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment." Stroke 52, no. 1 (2021): 203–12. http://dx.doi.org/10.1161/strokeaha.120.029292.
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Background and Purpose: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0–3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2–3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0–1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0–2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72–20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21–5.51]). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.
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Li, Zongdong, Michael A. Nardi, Yong-Sheng Li, et al. "C-terminal ADAMTS-18 fragment induces oxidative platelet fragmentation, dissolves platelet aggregates, and protects against carotid artery occlusion and cerebral stroke." Blood 113, no. 24 (2009): 6051–60. http://dx.doi.org/10.1182/blood-2008-07-170571.
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Abstract Anti-platelet integrin GPIIIa49-66 antibody (Ab) induces complement-independent platelet oxidative fragmentation and death by generation of platelet peroxide following NADPH oxidase activation. A C-terminal 385–amino acid fragment of ADAMTS-18 (a disintegrin metalloproteinase with thrombospondin motifs produced in endothelial cells) induces oxidative platelet fragmentation in an identical kinetic fashion as anti–GPIIIa49-66 Ab. Endothelial cell ADAMTS-18 secretion is enhanced by thrombin and activated by thrombin cleavage to fragment platelets. Platelet aggregates produced ex vivo with ADP or collagen and fibrinogen are destroyed by the C-terminal ADAMTS-18 fragment. Anti–ADAMTS-18 Ab shortens the tail vein bleeding time. The C-terminal fragment protects against FeCI3-induced carotid artery thrombosis as well as cerebral infarction in a postischemic stroke model. Thus, a new mechanism is proposed for platelet thrombus clearance, via platelet oxidative fragmentation induced by thrombin cleavage of ADAMTS-18.
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Maegerlein, Christian, Sebastian Mönch, Tobias Boeckh-Behrens, et al. "PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy – evaluation of a double embolic protection approach in endovascular stroke treatment." Journal of NeuroInterventional Surgery 10, no. 8 (2017): 751–55. http://dx.doi.org/10.1136/neurintsurg-2017-013558.
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PurposeStent retriever-based mechanical thrombectomy (MT) for emergent large vessel occlusions (ELVO) is often complicated by thrombus fragmentation causing distal embolization and embolization to new vascular territories. Well-established embolic protection approaches include proximal flow arrest and distal aspiration techniques during stent retriever maneuvers. Aiming at the reduction of thrombus fragmentation during MT we evaluated a technical approach combining proximal balloon occlusion together with direct thrombus aspiration during MT: the PROTECT technique.MethodsWe performed a case-control study comparing the PROTECT technique with sole distal aspiration during MT regarding technical and procedural parameters, n=200 patients with ELVO of either the terminus of the internal carotid artery or the proximal middle artery were included.ResultsPROTECT resulted in a shorter procedure time (29 vs 40 min; P=0.002), in a higher rate of successful recanalizations (100% vs 78%; P=0.001) and a higher rate of complete reperfusions (70% vs 39%; P<0.001) compared with sole distal aspiration during MT.ConclusionThe PROTECT technique is a promising new approach to significantly reduce thrombus fragmentation and, hence distal embolization during MT. This safe and efficient technique needs to be validated in larger trials to confirm our results.
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Aludin, Schekeb, Philipp Jost Schäfer, Christoph Borzikowsky, et al. "Experimental Evaluation of the Effectiveness of Aspiration-Based Techniques to Treat Different Types of Acute Thromboembolic Occlusions in the Femoropopliteal Vascular System Using an In Vitro Flow Model." CardioVascular and Interventional Radiology 45, no. 2 (2021): 228–35. http://dx.doi.org/10.1007/s00270-021-03024-8.
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Abstract Purpose In this in vitro study, the effectiveness and safety of four aspiration-based techniques for thrombectomy are evaluated for three types of thrombi in a flow model simulating the femoropopliteal segment. Material and Methods Red, white, and mixed thrombi were produced in a standardized manner and used to simulate occlusion of a superficial femoral artery using a pulsatile flow model. Four techniques were compared: aspiration alone, aspiration + stent retriever, exposing thrombus to laser by an excimer laser system and a laser catheter + aspiration, and aspiration + mechanical fragmentation by a separator. Rate of first-pass recanalization, embolic events, and number of embolized fragments > 1 mm were compared. Results Aspiration alone, stent retriever, laser, and separator differed in rates of first-pass recanalization (53.3%; 86.6%; 20%; and 100%) and embolic events (40%; 93.3%; 73.3%; and 60%). Number of embolized fragments was lowest with aspiration and higher with separator, laser, and stent retriever. Rates of first-pass-recanalization (75%; 75%; and 45%) and embolic events (65%; 60%; and 75%) differed for red, white, and mixed thrombi. The mixed thrombus caused the highest number of embolized fragments, which was particularly high using the stent retriever. Conclusion Additional use of mechanical techniques significantly enhances the effectiveness of thrombectomy but simultaneously provokes more embolism. Laser seems to negatively alter the structure of a thrombus and thus diminishes the effectiveness, while provoking embolism. All techniques had lowest effectiveness, but highest embolism with the mixed thrombus. This was particularly striking when a stent retriever was used with the mixed thrombus.
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Kaesmacher, J., T. Boeckh-Behrens, S. Simon, et al. "Risk of Thrombus Fragmentation during Endovascular Stroke Treatment." American Journal of Neuroradiology 38, no. 5 (2017): 991–98. http://dx.doi.org/10.3174/ajnr.a5105.
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Price, G., and E. C. Martin. "A FLEXIBLE ULTRASONIC GUIDE WIRE FOR THROMBUS FRAGMENTATION." Investigative Radiology 24, no. 12 (1989): S125. http://dx.doi.org/10.1097/00004424-198912000-00209.
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Cordella, Alessia, Pascaline Pey, Nikolina Linta, et al. "Use of Contrast-Enhanced Ultrasonography for the Characterization of Tumor Thrombi in Seven Dogs." Animals 10, no. 9 (2020): 1613. http://dx.doi.org/10.3390/ani10091613.
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Tumors of adrenal and thyroid glands have been associated with vascular invasions—so-called tumor thrombi, both in humans and dogs. The detection and characterization of venous thrombi is an important diagnostic step in patients with primary tumors for both surgical planning and prognosis. The aim of this study was to describe the use of contrast-enhanced ultrasonography (CEUS) for the characterization of tumor thrombi. Dogs with tumor thrombus who underwent bi-dimensional ultrasound (B-mode US) and CEUS were included. Seven dogs were enrolled in this retrospective case series. On B-mode US, all thrombi were visualized, and vascular distension and thrombus-tumor continuity were seen in three and two cases, respectively. On color Doppler examination, all thrombi were identified, seemed non-occlusive and only two presented vascularity. On CEUS, arterial-phase enhancement and washout in the venous phase were observed in all cases. Non-enhancing areas were identified in the tumor thrombi most likely representing non-vascularized tissue that could potentially be embolized in the lungs after fragmentation of the tumor thrombi. On the basis of these preliminary study, CEUS appeared to be useful for the characterization of malignant intravascular invasion.
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Worku, Berhane, Kyle Blake, Iosif Gulkarov, Akhilesh Sista, and Arash Salemi. "Percutaneous Removal of Filter-Induced Iliocaval Thrombus Using the AngioVac Device." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 10, no. 3 (2015): 212–14. http://dx.doi.org/10.1097/imi.0000000000000156.
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Most percutaneous mechanical thrombectomy devices entail thrombolysis and/or thrombus fragmentation followed by subsequent aspiration, with the associated risks of bleeding and embolization. We describe the use of the AngioVac system (Angiodynamics, Latham, NY USA) for extraction of extensive iliocaval thrombus associated with an inferior vena cava filter followed by percutaneous inferior vena cava filter extraction in a patient with an absolute contraindication to thrombolysis. The AngioVac may be considered in this scenario as it does not require thrombolytics and can remove whole thrombus, thus overcoming some of the limitations of percutaneous mechanical thrombectomy devices in the setting of subacute and early chronic thrombus.
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Kutlu, Ramazan, Alpay Alkan, Ayhan Kocak, and Kaya Sarac. "Thrombolysis and Mechanical Fragmentation to Treat Massive Pulmonary Embolism in a Patient with an Anterior Communicating Artery Aneurysm." Journal of Endovascular Therapy 10, no. 2 (2003): 332–35. http://dx.doi.org/10.1177/152660280301000225.
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Purpose: To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm. Case Report: An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated. Conclusions: Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.
Book chapters on the topic "Thrombus fragmentation"
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Wijdicks, Eelco F. M. "Acute Basilar Artery Occlusion." In The Clinical Practice Of Critical Care Neurology. Oxford University PressNew York, NY, 2003. http://dx.doi.org/10.1093/oso/9780195157291.003.0017.
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Abstract Patients with acute occlusion of the basilar artery may have rapid deterioration to coma and then often need to be intubated. The need for mechanical ventilation in this disorder marks a very poor prognosis, and if no endovascular intervention is available or considered, death from propagating clot may follow. In other patients, progression of brain stem dysfunction has not yet occurred or the neurologic deficit is limited. Patients in both categories are admitted with some frequency to the NICU. When they arrive early, management ranges from blood pressure augmentation to lysis or fragmentation of the thrombus by advancement of an intra-arterial catheter.
Conference papers on the topic "Thrombus fragmentation"
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Schmiech, Jonte, Helena Guerreiro, Nadine MacMillan, et al. "Quantitative Analysis of Periprocedural Thrombus Fragmentation using an Automated Optical Detection System in a Comprehensive Stroke Intervention Training Platform." In 2025 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2025. https://doi.org/10.1115/dmd2025-1017.
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Abstract Mechanical thrombectomy for occluded large brain vessels in acute ischemic stroke has proven highly effective, but periprocedural thrombus fragmentation (PTF) remains a significant challenge that can lead to downstream embolization and incomplete recanalization. While laboratory methods exist for detailed PTF analysis, practical solutions are needed for quantitative assessment of simulated thrombectomy procedures performed on physical training models. We present a novel measurement system that enables automated detection and quantification of thrombus fragmentation events during simulated thrombectomy procedures on the HANNES neurointerventional simulator. The system employs a six-channel measurement chamber with integrated UV illumination and an optical detection setup to track fluorescent thrombus fragments. Fragments are automatically detected, assigned IDs, and measured in real-time using computer vision techniques. Validation studies comparing the system's measurements to microscopic analysis demonstrated strong correlation (Pearson's r=0.9939, p&lt;0.001). In controlled testing, the system achieved 100% sensitivity and specificity for single fragment detection, successfully measuring fragments as small as 642 μm in radius. While adhering fragments are currently treated as quantify PTF events in real-time provides an objective basis for evaluating procedural performance and comparing thrombectomy techniques in training scenarios. This novel measurement system represents a practical advance for studying thrombus fragmentation in educational settings. Integration into comprehensive training platforms like HANNES could improve understanding and management of PTF risks, potentially leading to better patient outcomes through enhanced operator training. Future studies correlating PTF metrics with physician experience and clinical results may establish performance benchmarks to help quantify individual proficiency and predict clinical competency.
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Falk, E. A. "UNSTABLE ANGINA PECTORIS: PATHOLOGIC ASPECTS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643711.
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Unstable angina pectoris represents a common and important manifestation of acute ischemic heart disease encompassing the broad spectrum of clinical syndromes between stable effort angina and acute myocardial infarction. This group of patientsisfar from uniform concerning underlying pathogenetic mechanisms and prognosis, but generally the risk of infarction or deathis increased during the unstable period. Most patients are presenting with new or worsening effort angina or angina at rest,and especially patients with rest anginaassociated with transient ECG changes seem to constitute a high risk subgroup. Transient reductions in coronary blood flow,rather than increases in myocardial oxygen demand, seem to play the major role in rest angina, indicating an underlying 'dynamic' coronary stenosis.Furthermore, unstable angina seems to beagood clinicalmarker for actively progressing coronary-artery disease.Pathologically, a rapidly evolving coronary-artery lesion represented by a disrupted atherosclerotic plaque with variable degree of plaque hemorrhage and luminalthrombosis usually is present in patientscoming to autopsy after a period of rest angina. The thrombus at the rupture site may be mural and limited (just sealing therupture) or occlusive depending on the degree of preexisting atherosclerotic stenosis. An occlusive thrombus is seldom seen over ruptured plaques causing less tha15% stenosis (histologic area stenosis), but is found with increasing frequency when stenosis severety increases beyond 15%.Most occlusive thrombi have a layered structure with thrombus material of differing age indicating an episodic growth by repeated mural deposits. Aggregated platelets usually can be identified in the mostrecent part of the thrombus, while older parts are more homogeneous due to fibrin infiltration/stabilization. Additionally,microemboli and microinfarcts are frequently found in the myocardium downstream tocoronary thrombi. So, the period of unstable angina preceding a fatal heart attackseems to be characterized by an ongoing thrombotic process in a major coronary artery where recurrent mural thrombus formation alternates with intermittent thrombus fragmentation and peripheral embolization. Such a dynamic thrombosis (with or without a concomitant focal vasospastic phenomenon) at the site of an unstable (ruptured) atherosclerotic lesion obviously may lead to the other clearly thrombus-related acute ischemic events: myocardial infarction or sudden death.Clinical studies using coronary angiography and coronary angioscopy during the acute phase of unstable angina have revealed a high frequency of ulcerated (unstable) atherothrombotic lesion in arteries responsible for the acute ischemia. Furthermore, episodic platelet activation (usually associated with chest pain) has recently been demonstrated in patients with unstable angina.The mechanism underlying pain/ischemia(predominantly spasm?) and the rapid plaque progression (plaque hemorr.hage/luminal thrombosis?) during unstable angina maydiffer. Accordingly, therapy directed against a possible spasm (nitrates, calcium antagonists) usually relieves pain effectively without having any documented effect on infarction/survival, while antithr-ombotic therapy (aspirin, heparin) clearlyimproves the prognosis without apparent antianginal effect. Therefore, with the objective not only of relieving pain but also of improving the prognosis, more attention should be paid to the potentially fatal thrombotic process that apparently isgoing on in a major coronary artery of many patients with unstable angina.
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Szabo, T. "FRAGMENTATION OF CERULOPLASMIN BY THROMBINF." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644663.
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Copper containing proteolytic fragments of ceruloplasmin (CP), a 135 KDα2 -glycoprotein, have been shown to induce angiogenesis in the rabbit cornea assay.Neovascularisation plays an important role in different biological phenomena including chronic inflammation, wound healing, recanalisation of occluded blood vessels, tumor growth etc. Most of these events are associated with elevated CP levels. Neovascularisation occurs in diabetic macro- and microangiopathies as well. Serum CP concentrations in 92 diabetics were measured and compored to 50 healthy blood donors and 50 unselected hospitalized patients without malignancies. A marked CP elevation was observed in diabetics, especially in those with vascular complications. There was no correlation between the CP and the actual blood glucose concentrations, duration of the disease of the type of the treatment. Activation of the haemostatic processes has been found in the majority of diabetic patients with vascular diseases. In case CP is a substrate for thrombin, the generation of this specific serine protease may lead to the release of angiogenic peptides from CP on the site of vascular occlusion. For this reason, purified human CP was incubated with thrombin at pH 7.4, 37×C, and samples were removed at 0, 30, 60, 120, 240, min., and\after 2k hours for CP oxidase activity measurements and for SDS PAGE. Thrombin treatment did not affect the enzymic activity of CP. On SDS PAGE the band corresponding to the parent molecule eventually disappeared, and a Mr ll6 KD fragment together with three smaller peptides has been produced, with molecular masses 61, 4l and 20 KD, respectively. Based on these experiments, CP is to be considered as a new protein substrate for thrombin. The physiological relevance of this phenomenon needs further examination.