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Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography

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Title: Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography
Authors: Ludhmila Abrahão Hajjar, Marco B. Ancona, Roberto Kalil Filho, Moreno Tresoldi, José Guilherme Caldas, Giacomo Monti, Francisco Cesar Carnevale, Francesco De Cobelli, André Moreira de Assis, Fabio Ciceri, Giovanni Landoni, Jouke Dijkstra, Francesco Moroni, Alexandre Antônio Cunha Abizaid, Fernanda Willemann Ungaretti, Maria José Carvalho Carmona, Daniel De Backer, Carlos Eduardo Pompilio, Fábio S. de Britto, Carlos M. Campos, Alberto Zangrillo, Matteo Montorfano
Source: Frontiers in Medicine, Vol 10 (2023)
Publisher Information: Frontiers Media S.A., 2023.
Publication Year: 2023
Collection: LCC:Medicine (General)
Subject Terms: COVID-19, MicroClots, OCT, thrombo-inflammatory syndrome, D-dimer, Medicine (General), R5-920
More Details: BackgroundMicrovascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome.MethodsThe COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients.ResultsA total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients.ConclusionOCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis.Clinical trial registrationClinicalTrial.gov, identifier NCT04410549.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2296-858X
Relation: https://www.frontiersin.org/articles/10.3389/fmed.2023.1050531/full; https://doaj.org/toc/2296-858X
DOI: 10.3389/fmed.2023.1050531
Access URL: https://doaj.org/article/45626f662095495e965257f4d9da4336
Accession Number: edsdoj.45626f662095495e965257f4d9da4336
Database: Directory of Open Access Journals
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  Data: BackgroundMicrovascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome.MethodsThe COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer &gt; 10,000 ng/mL or 5,000 &lt; D-dimer &lt; 10,000 ng/mL and one of: C-reactive Protein &gt; 100 mg/dL, IL-6 &gt; 6 pg/mL, or ferritin &gt; 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients.ResultsA total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 &#177; 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 &#177; 4.6 mm2, with stenosis of 60.9 &#177; 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 &#177; 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 &#177; 2.6, and the mean thrombus-containing lesion length was 14.1 &#177; 13.9 mm. No peri-procedural complications occurred in any of the 13 patients.ConclusionOCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis.Clinical trial registrationClinicalTrial.gov, identifier NCT04410549.
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