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Tissue Preparation Techniques for Contrast-Enhanced Micro Computed Tomography Imaging of Large Mammalian Cardiac Models with Chronic Disease
Published on: February 8, 2022
Rationale and design of a prospective, observational study for the QUantitative EStimation of Thrombus burden in
Efstratios Karagiannidis1, Nikolaos V Konstantinidis1, Georgios Sofidis1
1First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
Insights
This study introduces micro-Computed Tomography (micro-CT) to analyze thrombus characteristics in ST-elevation myocardial infarction (STEMI) patients. This novel approach aims to improve risk stratification beyond traditional methods.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Thrombus presence in ST-elevation myocardial infarction (STEMI) correlates with adverse outcomes, yet routine thrombus aspiration lacks proven efficacy.
- Current risk stratification methods using clinical, laboratory, and angiographic data are insufficient for STEMI patients.
- Thrombus characteristics from aspirated material offer a potential, unaddressed parameter for improved patient classification.
Purpose of the Study:
- To describe a methodological analysis of coronary thrombi from STEMI patients using micro-Computed Tomography (micro-CT).
- To combine micro-CT thrombus data with traditional factors for a more powerful risk-stratification system.
- To explore the association of thrombus volume and density with clinical and angiographic outcomes.
Main Methods:
- Eighty-seven STEMI patients undergoing thrombus aspiration were enrolled.
- Aspirated thrombi were analyzed using micro-CT to generate 3D models, calculating volume and density.
- The study explored associations between micro-CT-derived thrombus variables and clinical/angiographic outcomes.
Main Results:
- Micro-Computed Tomography (micro-CT) was utilized for volumetric assessment of coronary thrombi in STEMI patients.
- The study established a methodology for 3D thrombus analysis, assessing volume and density.
- Associations between thrombus characteristics and patient outcomes were explored.
Conclusions:
- The QUEST-STEMI study pioneers volumetric coronary thrombus assessment via micro-CT.
- This imaging technique holds potential for larger trials to stratify STEMI patients by thrombus burden and adverse outcome risk.
Background:
Although the presence of thrombus in patients with ST-elevation myocardial infarction (STEMI) has been linked to adverse outcomes, routine thrombus aspiration has not been proven effective. A potential explanation is that these patients should be risk-stratified. Traditional clinical, laboratory and angiographic parameters used in clinical trials have been proven inadequate to classify patients. Aspirated thrombotic material characteristics might be an additional important parameter that has not yet been addressed. In this report, we aim to describe a methodological analysis of thrombus aspirated from coronary arteries during primary PCI using micro-Computed Τomography (micro-CT). These data will be combined with traditional factors to develop a risk-stratification system with high discriminative power for these patients.
Methods:
Eighty-seven patients with STEMI undergoing thrombus aspiration in AHEPA University Hospital, Greece, will be enrolled in the study. The first patient was enrolled in June 2018. After being aspirated, thrombi are preserved in formalin and their volume and density are calculated with micro-CT. Micro-CT allows us to create 3D models of thrombi from a series of x-ray projection images. These models are further analyzed to find the volume and density of extracted thrombi and to assess potential differences in their structure. Association of these variables with clinical parameters and angiographic outcomes will be explored.
Discussion:
QUEST-STEMI is-to our knowledge-the first study of volumetric coronary thrombus assessment by micro-CT. This method could be used in larger, clinically-oriented trials to help stratify patients with thrombus burden according to their risk for adverse outcomes.
Trial Registration:
QUEST-STEMI trial ClinicalTrials.gov number: NCT03429608 Date of registration: February 12, 2018. The study was prospectively registered (registered prior to enrollment of the first participant).
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