Cardiovascular Thrombus. From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions

Table of Contents

Section 1. Pathology 1. Hemostasis and thrombosis 2. Vascular wall pathology- effect on thrombosis 3. Mechanisms of thrombosis and their relationship to atherosclerosis: Endothelial cell function and injury [trauma, infection] 4. Platelet aggregation in the pathogenesis of vascular ischemia conditions 5. Physical properties and morphologic features of thrombus 6. Pathology of arterial thrombosis 7. Thrombus types 8. The calcified thrombus: histopathology 9. Pathology of venous thrombosis 10. Hypercoagulopathy: acquired syndromes and thrombosis 11. Hypercoagulopathy: hereditary syndromes and thrombosis 12. Intra cardiac thrombosis: ventricles, atria, appendage and valves 13. Prosthetic surgical valves and TAVR thrombosis 14. Closure devices and thrombosis

Section 2. Clinical presentations 15. Thrombotic ischemic syndromes of the coronary circulation 16. Thrombotic ischemic syndromes of the brain 17. Thrombotic syndromes of the peripheral arterial circulation 18. Thrombosis of the splanchnic and mesenteric 19. Unique thrombus-containing lesions 20. Thrombosis of the venous system: DVT; portal vein; renal vein; Superior vena cava; Jugular; Budd-Chiari; cavernous sinus; cerebral 21. The angry thrombus phenomenon and the simultaneous thrombus in different vascular beds 22. Pulmonary embolism-acute 23. Pulmonary embolism: chronic 24. Platelets, thrombus and thrombosis in pregnancy 25. Atrial fibrillation and thromboembolism

Section 3. Diagnosis 26. Cardiovascular Thrombus classifications 27. Laboratory studies of thrombus and thrombosis 28. Imaging modalities

Section 4. Treatment Guidelines 29. The role of treatment guidelines-comparing the US and European approach to cardiovascular thrombus

Section 5. Pharmacotherapy 30. From Coumadin to the new anticoagulation agents 31. Antiplatelet agents: asa; heparins; LMH 32. Direct thrombin inhibitors 33. The 2b/3a receptor antagonists 34. Thienopyridines 35. Thrombolytic agents

Section 6. Interventions 36. Percutaneous approach: 37. Protection filters 38. Mechanical thrombectomy: Angiojet and X-Sizer 39. Stents: dedicated thrombus containing stent platforms 40. Extraction and vaporization devices: thrombocat and laser 41. LAA closure 42. Surgical approach

Section 6. Future trends 43. Pharmacotherapy and technology

Authors

On Topaz Professor of Medicine, School of Medicine, Duke University, Cardiologist, Division of Cardiology, Charles George Veterans Affairs Medical Center, Asheville, NC, USA. Professor On Topaz received the MD degree in 1979 from the Sackler School of Medicine, Tel-Aviv University and completed residencies in Internal Medicine and Cardiology at the Beilinson and Meir hospitals, Israel. He is a graduate of 3 clinical and research US fellowships including Cardiovascular Pathology at the University of Minnesota [1983-1984], adult Cardiology at the University of Miami [1986-1989] and Interventional Cardiology at the Medical College of Virginia[1989-1990]. Following this extensive training he became an Assistant Professor at Case Western Reserve University and then at the University of Minnesota. In 1993 he joined the division of cardiology, Medical College of Virginia/Virginia Commonwealth University in Richmond, Virginia with a rank of Associate Professor serving as the director of interventional cardiology of the McGuire Veterans Affairs Medical Center . He was a member of the admissions committee of this school of medicine for 11 years . In 2001 he received the rank of Professor of Medicine and in 2002 received as well as a rank of Professor of Pathology. In 2010 he was nominated the chief of the division of Cardiology of Charles George Veterans Affairs Medical Center in Asheville, North Carolina with a rank of Professor of Medicine at the Duke University School of Medicine.
Professor Topaz's main clinical specialty is percutaneous interventions for complex lesion subsets in challenging coronary and peripheral vascular targets. He specializes in treatment of patients with critical lesions in the presence of depressed LVEF, severe left main disease, old saphenous vein grafts, chronic total occlusions, stent thrombosis and heart transplant allograft disease . He has special interest in revascularization of severe renal artery stenosis and severe subclavian artery occlusions. Professor Topaz is the inventor of several percutaneous revascularization techniques with advanced debulking technology for plaque extraction and thrombus removal. He is also a national and international proctor of FDA approved plaque debulking and thrombectomy devices such as laser and rheolytic thrombectomy.
Professor Topaz's clinical investigations and basic research focus on cardiovascular thrombus including pathology and exploration and development of dedicated revascularization strategies for management of thrombus and its constituents during various phases of coronary and peripheral ischemic syndromes . He has gained global recognition for contribution to the understanding and the treatment of thrombotic lesions in acute ischemic/ thrombotic coronary and peripheral syndromes and authored the chapter on The thrombus containing lesion for several editions of the Textbook of Interventional Cardiology ,edited by Topol and Teirstein and published by Elsevier.
Professor Topaz is a world authority on cardiovascular lasers whereby he pioneered the contemporary coronary lasing techniques and introduced the utilization of laser revascularization in acute myocardial infarction. In addition, he developed laser application for treatment of congenital heart conditions such as pulmonic atresia.
Professor Topaz conducts basic research on the effects of laser irradiation on cardiac and vascular bio-tissue with special focus on the interaction of laser energy with thrombus and platelets. He discovered the unique phenomena of laser- induced enhancement of thrombolytic agents activity and laser induced suppression of platelet aggregation. Clinically , he investigates the therapeutic outcomes of various cardiovascular lasers.
Professor Topaz is a recognized researcher and scholar of cardiovascular pathology and vascular anatomy. In 2010 he discovered in several patients the existence of a previously unknown, peripheral artery which constitutes origin of both inferior phrenic arteries as a vascular trunk from the right renal artery. The importance of this discovery was further emphasized as this vessel supplies unique, also newly discovered trans diaphragmatic cardiac collaterals. Recently, he and colleagues introduced an important paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia with emphasis on the performance of endovascular interventions in the inferior mesenteric artery.
Professor Topaz served on special study sections of the NIH and NSF and is a fellow of the American College of Cardiology, the American College of Physicians, the Society for Cardiac Angiography and Interventions, the American Society of Laser Medicine and Surgery, the Society of Vascular Medicine and a member of numerous cardiovascular societies and organizations. Professor Topaz is an invited faculty of leading international conferences in the field of interventional cardiology, whereby he participates as live case operator, lecturer, moderator , discussant and session chairperson . He has lectured, proctored and performed live coronary and peripheral interventions in many countries around the world. Between 1998 and 2005 he served as the North American Editor- in- Chief of the journal Laser in Medical Sciences, the clinical publication of the European Laser Association. He is the recipient of an NIH national research service award, the Winthrop interventional award and several teaching awards. In 2010 the McGuire Veterans Affairs medical center of Virginia Commonwealth University established the "On Topaz MD award”, presented annually to their best interventional cardiology fellow . To date, Professor Topaz has published 137 peer-reviewed articles; the textbook "Lasers in Cardiovascular interventions [Springer, UK, 2016]; the textbook "Cardiovascular Thrombus" [Elsevier, Philadelphia, USA, 2018]; 31 book chapters and a member of 18 peer-reviewed journals.23 book chapters and 56 abstracts. He is a reviewer and editorial board member of 16 peer-reviewed journals and a member of medical advisory boards.