Immunohistochemical Characteristics of Coronary Thrombi in Patients with ST-Elevation Myocardial Infarction and Diabetes Mellitus: Pilot Studyy

Ribeiro, Daniel Rios Pinto; Cambruzzi, Eduardo; Sebben, Juliana Cañedo; Melleu, Karina; Schmidt, Márcia Moura; Gottschall, Carlos Am; Quadros, Alexandre Schaan de

doi:10.1016/s2214-1235(15)30006-5

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“…In the past, most studies of human of thrombus structure have used some type of light microscopy. 17 22 23 24 Similarly, fluorescence light microscopy has been used for monitoring of thrombus formation in mouse models 25 26 and human ex vivo models. 27 All these studies have yielded useful information, but we chose the SEM technique for acquiring structural data from human ex vivo thrombi taken from patients.…”

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confidence: 99%

Incorporation of Fibrin, Platelets, and Red Blood Cells into a Coronary Thrombus in Time and Space

et al. 2021

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We describe the internal structure, spatial organization and dynamic formation of coronary artery thrombi from ST-segment elevation myocardial infarction patients. Scanning electron microscopy (SEM) revealed significant differences among four groups of patients (<2 hours; 2–6 hours; 6–12 hours, and >12 hours) related to the time of ischemia. Coronary artery thrombi from patients presenting less than 2 hours after the infarction were almost entirely composed of platelets, with small amounts of fibrin and red blood cells. In contrast, thrombi from late presenters (>12 hours) consisted of mainly platelets at the distal end, where clotting was initiated, with almost no platelets at the proximal end, while the red blood cell content went from low at the initiating end to more than 90% at the proximal end. Furthermore, fibrin was present mainly on the outside of the thrombi and older thrombi contained thicker fibers. The red blood cells in late thrombi were compressed to a close-packed, tessellated array of polyhedral structures, called polyhedrocytes. Moreover, there was redistribution from the originally homogeneous composition to fibrin and platelets to the outside, with polyhedrocytes on the interior. The presence of polyhedrocytes and the redistribution of components are signs of in vivo clot contraction (or retraction). These results suggest why later thrombi are resistant to fibrinolytic agents and other treatment modalities, since the close-packed polyhedrocytes form a nearly impermeable seal. Furthermore, it is of particular clinical significance that these findings suggest specific disparate therapies that will be most effective at different stages of thrombus development.

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