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Distinguishing characteristics of erythrocyte-rich and platelet-rich thrombus by intravascular ultrasound catheter system

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Abstract

Background

Acute coronary syndromes are associated with platelet-rich, white thrombi (WT) and erythrocyte-rich, red thrombi (RT), but their ultrasonic characteristics are not well defined. To determine whether intravascular ultrasound (IVUS) could be used to detect specific characteristics of WT and RT, two experiments were performed.

Methods

An in-vitro experiment evaluated five WT and five RT and an ex-vivo experiment evaluated thrombi from 17 atherosclerotic rabbits with disrupted plaques and overlying thrombi. Specimen were mounted flat, immersed in a saline bath and examined from the intimal surface. Thrombi were classified as WT (n = 69) or RT (n = 40) by gross inspection and histology. IVUS was performed using a 1 mm, 20 MHz transducer in a 4.8F catheter. Images were digitally converted and points integrated to account for angular and depth resolution. Sampling was performed at the water-tissue interface and four other sites at 0.3 mm radial depth increments. Signals from each depth were standardized by obtaining the ratio of each energy level to the level at the water-tissue interface.

Results

The average energy ratio backscattered by RT was constant with increasing tissue depth while it attenuated for WT (P < 0.005; 2-way ANOVA). RT was less homogeneous and had more backscatter compared to WT. Light and electron microscopy corroborated these observations showing WT as densely homogenous and RT with loose cellular elements.

Conclusion

WT may be detected by its attenuated ultrasound pattern versus a non-attenuated pattern for RT by IVUS. This technique has potential for characterizing WT and RT.

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Acknowledgments

We thank Dr. Murray Mittleman for his assistance with statistical analysis, Dr. Micheline Federman, Department of Pathology, Harvard Medical School, Ralph Common Electron Microscopy facility of the Division of Human Pathology, Department of Physiology at Michigan State University for the electron microscopy and Jan Saxton for the light microscopy and technical support. We thank Dorothy Rybaczyk Pathak, Ph.D., Department of Epidemiology at Michigan State University for her help with statistical analysis. This study was supported by funds from the A. W. Ford Grant, American Society for Lasers in Medicine and Surgery, Wausau, Wisconsin, and the National Institutes of Health Grant (NHLBI, R01:HL36320), Bethesda, MD.

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Authors and Affiliations

  1. Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, MA, USA

    Eric Johnstone, Stephan E. Friedl & George S. Abela

  2. Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, MI, USA

    Alok Maheshwari & George S. Abela

Authors
  1. Eric Johnstone
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  2. Stephan E. Friedl
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  3. Alok Maheshwari
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  4. George S. Abela
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Corresponding author

Correspondence to George S. Abela.

Additional information

The work was supported in part from grants in aid from the National Institutes of Health (NHLBI, RO1-HL36320), Bethesda MD, and the A.W. Ford Memorial Fund, Wausau, WI.

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Johnstone, E., Friedl, S.E., Maheshwari, A. et al. Distinguishing characteristics of erythrocyte-rich and platelet-rich thrombus by intravascular ultrasound catheter system. J Thromb Thrombolysis 24, 233–239 (2007). https://doi.org/10.1007/s11239-007-0027-7

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  • DOI: https://doi.org/10.1007/s11239-007-0027-7

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