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首页> 外文期刊>Neurosurgical focus >Development of a recalcitrant, large clot burden, bifurcation occlusion model for mechanical thrombectomy
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Development of a recalcitrant, large clot burden, bifurcation occlusion model for mechanical thrombectomy

机译：机械血栓切除术顽强，血块负担大，分叉闭塞模型的开发

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OBJECTIVE Stroke is a major cause of disability and death in adults. Several large randomized clinical trials have shown the significant benefit of mechanical thrombectomy with modern stent retrievers in the treatment of large-vessel occlusions. However, large clots located at bifurcations remain challenging to treat. An in vivo model of these recalcitrant clots needs to be developed to test future generations of devices. METHODS Autologous blood was drawn from anesthetized swine via a femoral sheath. Blood was then mixed with thrombin, calcium chloride, and saline, and injected into silicone tubing to form cylindrical clots in the standard fashion. Matured clots were then delivered in an unfragmented fashion directly into the distal extracranial vasculature, at branch points where vessel sizes mimic the human middle cerebral artery, by using Penumbra aspiration tubing and the Penumbra ACE68 reperfusion catheter. RESULTS A total of 5 adult swine were used to develop the model. The techniques evolved during experiments in the first 3 animals, and the last 2 were used to establish the final model. In these 2 swine, a total of 8 autologous clots, 15–20 mm, were injected directly into 8 distal extracranial vessels at branch points to mimic a bifurcation occlusion in a human. All clots were delivered directly at a distal bifurcation or trifurcation in an unfragmented fashion to cause an occlusion. Ten revascularization attempts were made, and none of the branch-point occlusions were fully revascularized on the first attempt. CONCLUSIONS Using novel large-bore distal access catheters, large unfragmented clots can be delivered into distal extracranial vessels in a swine occlusion model. The model mimics the clinical situation of a recalcitrant bifurcation occlusion and will be valuable in the study of next-generation stroke devices and in training settings.
机译：目的中风是成年人残疾和死亡的主要原因。几项大型随机临床试验表明，采用现代支架取出器进行机械血栓切除术可治疗大血管阻塞。然而，位于分叉处的大血块仍然难以治疗。需要开发这些顽固凝块的体内模型，以测试下一代设备。方法从麻醉的猪经股鞘抽取自体血。然后将血液与凝血酶，氯化钙和盐水混合，并以标准方式注入硅胶管中以形成圆柱形血块。然后，通过使用Penumbra抽吸管和Penumbra ACE68再灌注导管，将成熟的血块以无碎片的方式直接输送到颅外远端脉管系统中的分支点，在分支点处，血管大小模仿人的大脑中动脉。结果总共使用了5只成年猪来建立模型。该技术是在实验过程中在前3只动物中发展起来的，而后2只动物则用于建立最终模型。在这2头猪中，将总共8个15-20 mm的自体血块直接注射到8个远端颅外血管的分支点上，以模拟人的分叉闭塞。所有血块均以无碎片的方式直接在远端分叉处或三叉处递送，以引起阻塞。进行了10次血运重建尝试，并且第一次尝试都没有对所有分支点阻塞进行完全血运重建。结论使用新颖的大口径远端入路导管，可以在猪闭塞模型中将大块的未凝结血块输送到远端颅外血管中。该模型模仿了顽固的分叉闭塞的临床情况，在研究下一代中风装置和训练环境中将具有重要的价值。

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