Presence of a distinct neural component in congenital vascular malformations relates to the histological type and location of the lesion

Congruency of the development of peripheral nerves and blood vessels has been well described, and usually, the nerves and blood vessels follow each other during development. Although little is known about the existence of a substantial neural component in vascular malformations, we investigate the presence of an intralesional component of nerve bundles in congenital vascular malformations of soft tissues. Resection specimens of 130 congenital vascular malformations of soft tissue were retrospectively screened for the presence and extent of intralesional mature nerves bundles. Lesions were histologically categorized in arteriovenous malformations (n = 83), pure venous malformations (n = 33), and lymphatic-venous malformations (n = 14). For identification of nerves, all sections were immunostained with anti-S100. GLUT-1 immunostaining excluded the presence of infantile hemangiomas in these series. Of 130 cases, 96 (74%) showed a substantial increase of intralesional nerves in close apposition to the vessels. The nervous component appeared to be more extensive in the head and neck region and upper extremities than in malformations of other topographic sites. Most cases of arteriovenous malformations showed an increase in nerve elements (87% of all arteriovenous malformations), which was more than in pure venous malformations (55%). In cases of lymphatic-venous malformations, the areas composed of lymphatic vessels showed ail almost complete absence of nerves. Prior Surgery in the malformation gave no different nerve pattern compared to cases that were surgically treated for the first time. The abundant presence of intralesional mature nerves in most congenital vascular malformations suggests that at least in a large subset of lesions, neural components are an integral part of the developmental disorder. This is particularly evident in the arteriovenous type of malformations and lesions that arise in the head and neck region of the body. (c) 2009 Elsevier Inc. All rights reserve

Plaque instability frequently occurs days or weeks before occlusive coronary thrombosis - A pathological thrombectomy study in primary percutaneous coronary intervention

Background - Acute ST-elevation myocardial infarction (STEMI) is caused by sudden occlusive coronary thrombosis, after plaque disruption; however, a considerable time interval between plaque disturbance and the onset of symptoms has been suggested. We therefore studied the age of intracoronary thrombi, aspirated during angioplasty in patients with acute STEMI. Methods and Results - Percutaneous intracoronary thrombectomy during angioplasty was performed in 211 consecutive STEMI patients within 6 hours after onset of anginal symptoms. The aspirated material was histologically screened on thrombus and plaque components, and thrombus age was classified as fresh ( 5 days). In all patients, intracoronary-derived material was retrieved in the filter of the collection bottle. Thrombus was identified in 199 (95 %) of 211 patients. In 12 patients (5 %), only plaque components were identified, and in 85 patients (41 %), both thrombus and plaque material were aspirated. In 18 (9 %) of 199 patients, the thrombus was organized, and in 70 patients (35 %), the thrombus showed lytic changes, whereas in 98 (49 %), a completely fresh thrombus was found. In 14 (7 %) of 199 patients, the thrombus showed combined features of both fresh thrombus and organized thrombus. Conclusions - In at least 50 % of patients with acute STEMI, coronary thrombi were days or weeks old. This indicates that sudden coronary occlusion is often preceded by a variable period of plaque instability and thrombus formation, initiated days or weeks before onset of symptom

Presence of Older Thrombus Is an Independent Predictor of Long-Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Thrombus Aspiration During Primary Percutaneous Coronary Intervention

Background-Routine thrombus aspiration is frequently used during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction to prevent distal embolization. Recently, evidence of clinical benefit was published. In 50% of the ST-elevation myocardial infarction patients with an onset of symptoms 1 day old. This observation illustrates that plaque rupture and coronary occlusion are significantly separated in time. In the present study, we correlate the presence of fresh versus older thrombus with long-term mortality. Methods and Results-Thrombus aspiration was performed in 1315 patients treated with primary percutaneous coronary intervention with 3 devices (Rescue, Export, and Proxis). Aspirated material was fixed in formalin and processed for histopathology. If possible, thrombus age was classified as either fresh only ( 1 day). We identified fresh thrombus in 552 patients and older thrombus in 372 patients. The cumulative Kaplan-Meier estimate of all-cause mortality at 4 years was significantly higher in patients with older thrombus (16.0%) compared with patients with fresh thrombus (7.4%), with a hazard ratio of 1.82 (95% confidence interval, 1.17 to 2.85; P=0.008). Multivariate analysis identified the presence of older thrombus, in addition to other established predictors, as an independent predictor (hazard ratio, 1.83; 95% confidence interval, 1.14 to 2.93; P=0.01) of long-term mortality. Conclusion-Our study demonstrates that the presence of older thrombus, in addition to other established predictors, is an independent predictor of long-term mortality in patients with ST-elevation myocardial infarction treated with thrombus aspiration during primary percutaneous coronary intervention. (Circulation. 2008; 118: 1810-1816.