Platelets and endothelium: effect of collagen-induced platelet aggregates on pulmonary vessels

Thrombus aspiration during primary percutaneous coronary intervention

BACKGROUND

Primary percutaneous coronary intervention (PCI) is effective in opening the infarct-related artery in patients with myocardial infarction with ST-segment elevation. However, the embolization of atherothrombotic debris induces microvascular obstruction and diminishes myocardial reperfusion.

METHODS

We performed a randomized trial assessing whether manual aspiration was superior to conventional treatment during primary PCI. A total of 1071 patients were randomly assigned to the thrombus-aspiration group or the conventional-PCI group before undergoing coronary angiography. Aspiration was considered to be successful if there was histopathological evidence of atherothrombotic material. We assessed angiographic and electrocardiographic signs of myocardial reperfusion, as well as clinical outcome. The primary end point was a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively).

RESULTS

A myocardial blush grade of 0 or 1 occurred in 17.1% of the patients in the thrombus-aspiration group and in 26.3% of those in the conventional-PCI group (P<0.001). Complete resolution of ST-segment elevation occurred in 56.6% and 44.2% of patients, respectively (P<0.001). The benefit did not show heterogeneity among the baseline levels of the prespecified covariates. At 30 days, the rate of death in patients with a myocardial blush grade of 0 or 1, 2, and 3 was 5.2%, 2.9%, and 1.0%, respectively (P=0.003), and the rate of adverse events was 14.1%, 8.8%, and 4.2%, respectively (P<0.001). Histopathological examination confirmed successful aspiration in 72.9% of patients.

CONCLUSIONS

Thrombus aspiration is applicable in a large majority of patients with myocardial infarction with ST-segment elevation, and it results in better reperfusion and clinical outcomes than conventional PCI, irrespective of clinical and angiographic characteristics at baseline. (Current Controlled Trials number, ISRCTN16716833.)

Vascular injuries induced by materials released from white mural thrombus and hypercholesterolemia in vivo

Materials released from platelet-rich white mural thrombi into the arterial circulation and dietary hypercholesterolemia could cause endothelial injury and regeneration, and also smooth muscle cell migration and proliferation in vivo in the intima. In addition, a combination of these two factors showed an additive effect on the endothelial injury in vivo. Further experiments are in progress to clarify how high a level of serum cholesterol and/or oxidized LDL may be sufficient for endothelial injury using this in vivo model for the better understanding of detailed pathogenesis of atherosclerosis.

Vascular injuries induced by materials released from platelet-rich thrombus in vivo

Polyethylene tubing was inserted into the ascending aorta of rabbits via the right common carotid artery and placed for one or four weeks continuously to induce vessel wall injury and thrombotic events, and then the direct non-injured segments from the descending thoracic and abdominal aorta were examined morphologically and for [3H]thymidine incorporation into endothelial cells and smooth muscle cells. The descending aortas of experimental rabbits showed endothelial damage and increased mitosis of endothelial cells. [3H]Thymidine incorporation into the intima and media was significantly increased in the experimental group. This experiment indicates that materials released from activated platelets and/or thrombi into the circulation can cause endothelial damage and smooth muscle cell proliferation at downstream and remote aortic segments.

Effect of blood coagulation and platelet aggregation on perfusable capillaries and arterioles in ischemic and nonischemic myocardium

The aim of this study was to determine the effect of blood coagulation and platelet aggregation on the perfusability of arterioles (19-50 micron) and capillaries in subepicardial and subendocardial ischemic and nonischemic myocardium of anesthetized open-chest rabbits. Fluorescein isothiocynate-dextran (MW 150,000) was injected intravenously to label perfusable myocardial microvessels of rabbits that were subjected to 60 min of coronary artery occlusion. Fluorescent microscopy was used to identify the perfusable vessels and an alkaline phosphatase stain was employed to locate the total microvasculature of the heart. Stereological principles were utilized to determine various morphometric parameters. About 25% of the capillaries were incapable of being perfused but virtually all arterioles were perfusable in occluded myocardium of the control group. Essentially all capillaries and arterioles were perfusable in nonoccluded myocardium. Collagen infusion produced a perfusion defect in 14% of the capillaries and arterioles in nonoccluded myocardium and in 33% of the capillaries and arterioles in occluded myocardium. Heparin, prostaglandin E1 (PGE1), or PGE1 + heparin did not prevent the perfusion defect in capillaries of occluded myocardium. It is concluded that while promotion of blood coagulation and platelet aggregation was able to produce microvessel obstruction, these hemostatic mechanisms were not primarily responsible for the capillary obstruction observed during myocardial ischemia in the rabbit heart.

Role of the altered transmural permeability in the pathomechanism of arteriosclerosis. History of arteriosclerosis theories. Role of the altered permeability in experimental arteriosclerosis models

After presenting an overview on classification and history of arteriosclerosis theories, the physiological factors involved in the transmural permeability of the arteries are discussed in detail. The development and characteristic features of the altered transmural permeability were studied in various experimental models such as in rat's hypercholesterolemia, local aortic hypoxia, lymphedema of the vascular wall and in hypertension. Results appear to show that alterations in permeability invariably developed in all of the pathological conditions examined, they were transient in nature and preceded the onset of intimal proliferation(s). The disturbance of transmural permeability might be the common pathologic clue which initiates uniform vascular responses to injuries produced by a variety of noxious stimuli. The possible role of the altered transmural permeability in the induction of smooth muscle cell proliferation is also discussed and evidence is provided that after withdrawal of stimulus for vascular injury intimal proliferation will not develop despite the manifest disorders in permeability.

Relationship between the early arterial reaction to hypertension and the development of intimal proliferation

Malignant renal hypertension was induced in male Wistar rats. In the early phase of the disease, ie. the 1st week, a transient and generalized activation of arterial cellular functions was observed, while later, on day 21 widespread intimal proliferations developed in the arteries. This early activation included an increase in transmural permeability, DNA-, protein, collagen, elastin and ground substance synthesis, a rise in mural PGI2 content and an increase in number of Weibel-Palade bodies. An activation of platelets and monocytes could also be detected during the 1st week. In a group of rats the development of malignant hypertension was interrupted following the early activation of arteries and the incidence of intimal proliferations was compared with that of rats with maintained hypertension. No intimal proliferation was observed on day 21 in the rats with interrupted hypertension. It is concluded that the early activation of the artery does not furnish enough stimulus for triggering intimal proliferations and intimal plaques are not direct sequelae of the early arterial reaction. Furthermore the entrance of plasma materials during transmural permeability increase can not induce smooth muscle proliferation if the hypertension is interrupted.