Thrombin generation and platelet activation related to subintimal percutaneous transluminal angioplasty

Abstract

Objective: The purpose of this study was to measure the in vivo platelet activation and thrombin generation in arterial blood after passing a subintimal conduit. Methods: Subintimal percutaneous transluminal angioplasty (SPTA) is a technique where a subintimal channel is created, allowing recanalization of long peripheral arterial occlusion. From 10 patients with intermittent claudication, undergoing successful SPTA for femoropopliteal occlusive disease, we collected antecubital venous blood samples immediately before treatment, preprocedural arterial blood samples taken at the entry level proximal to the vessel occlusion, and subsequently at the reentry level after successful recanalization. Venous follow-up blood samples were taken after 24 hours. Plasma concentrations of β-thromboglobulin (β-TG), RANTES, and Prothrombin fragment (F1 + 2), were determined by immunoassay. Fibrinogen binding to platelets, leukocyte-platelet adhesion, and P-selectin were determined by flow cytometry. Results: We found a statistically significant transluminal increase in the plasma concentrations of RANTES, β-TG and F1 + 2 (p = 0.002, 0.001 and 0.001 respectively), which all normalized within 24 hours. Platelet-leukocyte aggregates significantly decreased after 24 hours compared with preprocedural and preentry levels (3.26% versus 5.26 %, p = 0.017). P-selectin expression on circulating platelets was statistically significantly increased in the blood sample taken at the re-entry level compared with the pre-procedural and pre-entry level (p = 0.007). After 24 hours there was no statistically significant difference to pre-procedural levels. There was no significant change in platelet fibrinogen binding at any levels. Conclusion: When passing a subintimal conduit, in vivo sampled blood demonstrated an extremely rapid and substantial uniform platelet activation and thrombin generation.

Key Words::

• Endovascular procedures
• subintimal angioplasty
• peripheral vascular disease
• thrombosis
• platelet activation
• flow cytometry
• thrombin generation
• cytokines

Acknowledgements

We would especially like to thank Tor Flørenes, senior consultant in vascular surgery, f6or enthusiastic support. Also, we want to thank Professor Andries Kroese, one of the initiators of this study. This work was supported by a grant from The Research Foundation, Oslo University Hospital, Aker.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.