A Porcine Model of Carotid Artery Thrombosis for Thrombolytic Therapy and Angioplasty: Application of PTFE Graft-Induced Stenosis

Lin, Peter H.; Chen, Changyi; Surowiec, Scott M.; Conklin, Brian S.; Bush, Ruth L.; Chaikof, Elliot L.; Lumsden, Alan B.; Weiss, Victor J.

doi:10.1177/152660280000700310

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…CT with local contrast agent injection is associated with considerable beam-hardening artifacts as a result of high concentration of contrast agent within the lysis catheter and unnecessary radiation exposure to the operator. Therefore, the increase of patent graft area was examined by angiography, consistent with clinical practice and previous publications (19,35,36). The use of an edge detection program increased the accuracy and reproducibility of the contrast area measurements as opposed to manual segmentation; adjustments were made by the blinded reviewer if necessary.…”

Section: Discussionmentioning

confidence: 89%

Pulsed High–Intensity-focused US and Tissue Plasminogen Activator (TPA) Versus TPA Alone for Thrombolysis of Occluded Bypass Graft in Swine

Abi-Jaoudeh

Pritchard

Amalou

et al. 2012

Journal of Vascular and Interventional Radiology

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Purpose Prosthetic arteriovenous or arterial-arterial bypass grafts can thrombose and be resistant to revascularization. A thrombosed bypass graft model was created to evaluate the potential therapeutic enhancement and safety profile of pulsed high-intensity-focused ultrasound (pHIFU) on pharmaceutical thrombolysis. Materials and Methods In swine, a right carotid-carotid expanded polytetrafluoroethylene bypass graft was surgically constructed, containing a 40% stenosis at its distal end to induce graft thrombosis. The revascularization procedure was performed 7 days after surgery. After model development and dose response experiments (n = 11), two cohorts were studied: pHIFU with tissue plasminogen activator (TPA; n = 4) and sham pHIFU with TPA (n = 3). The experiments were identical in both groups except no energy was delivered in the sham pHIFU group. Serial angiograms were obtained in all cases. The area of graft opacified by contrast medium on angiograms was quantified with digital image processing software. A blinded reviewer calculated the change in the graft area opacified by contrast medium and expressed it as a percentage, representing percentage of thrombolysis. Results Combining pHIFU with 0.5 mg of TPA resulted in a 52% ± 4% increase in thrombolysis on angiograms obtained at 30 minutes, compared with a 9% ± 14% increase with sham pHIFU and 0.5 mg TPA (P = .003). Histopathologic examination demonstrated no differences between the groups. Conclusions Thrombolysis of occluded bypass grafts was significantly increased when combining pHIFU and TPA versus sham pHIFU and TPA. These results suggest that application of pHIFU may augment thrombolysis with a reduced time and dose.

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Section: Discussionmentioning

confidence: 89%

Pulsed High–Intensity-focused US and Tissue Plasminogen Activator (TPA) Versus TPA Alone for Thrombolysis of Occluded Bypass Graft in Swine

Abi-Jaoudeh

Pritchard

Amalou

et al. 2012

Journal of Vascular and Interventional Radiology

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“…A full spectrum of procedures in a fully functioning arterial tree can be performed, and realistic endovascular access using a percutaneous or surgical cut-down technique is feasible. Even the lack of natural pathology has also been overcome with artificial induction of both occlusive and aneurysmal disease through iatrogenically injuring vessel endothelium [ 20 ] and suturing constricting prosthetic patches around surgically exposed vessels [ 21 ]. The Porcine Transfer Study [ 22 ] showed significantly improved performance parameters in novices undertaking an iliac stenting procedure after training on a porcine model.…”

Section: Resultsmentioning

confidence: 99%

The role of simulation in the development of endovascular surgical skills

Nesbitt¹,

Birdi²,

Mafeld

et al. 2016

Perspect Med Educ

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Endovascular trainees in the National Health Service still largely rely on the apprentice-apprenticeship model from the late 19th century. As the scope for endovascular therapy increases, due to the rapid innovation, evolution and refinement of technology, so too do patients’ therapeutic options. This climate has also opened the door for more novel training adjuncts, to address the gaps that exist in our current endovascular training curriculum. The aim of this paper is to present a succinct overview of endovascular simulation, synthesizing the trials and research behind this rapidly evolving training as well as highlighting areas where further research is required. The authors searched MEDLINE and EMBASE for relevant manuscripts on all aspects of endovascular simulation training. A comprehensive Google search was also undertaken to look for any relevant information on endovascular training courses available and any unpublished work that had been presented at relevant scientific meetings. Papers were categorized into the four models: synthetic, animal, virtual reality and human cadaver, and separate searches for evidence of skill transfer were also undertaken. Authors of novel research projects were contacted for further details of unpublished work and permission granted to report such findings in this manuscript.

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“…The inner diameter of the artificial vessel in the bioreactor, 4.57 mm, was selected to match the diameter of human coronary arteries 10,28 and the porcine carotid artery, 28,33 which is commonly used for ex vivo scaffolds in tissue engineering. Because porcine carotid arteries have a maximum usable length of approximately 80 mm 38 and approximately 60 mm of flow length after attachment to a bioreactor, the vessel working length was selected to be 60 mm.…”

Section: Experimental Conditionsmentioning

confidence: 99%

Wall Shear Stress Measurements in an Arterial Flow Bioreactor

Voigt

Buchanan

Rylander

et al. 2011

Cardiovasc Eng Tech

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In vitro arterial flow bioreactor systems are widely used in tissue engineering to investigate response of endothelial cells to shear. However, the assumption that such models reproduce physiological flow has not been experimentally tested. Furthermore, shear stresses experienced by the endothelium are generally calculated using a Poiseuille flow assumption. Understanding the performance of flow bioreactor systems is of great importance, since interpretation of biological responses hinges on the fidelity of such systems and the validity of underlying assumptions. Here we test the physiologic reliability of arterial flow bioreactors and the validity of the Poiseuille assumption for a typical system used in tissue engineering. A particle image velocimetry system was employed to experimentally measure the flow within the vessel with high spatial and temporal resolution. Two types of vessels were considered: first, fluorinated ethylene propylene (FEP) tubing representative of a human artery without cells; and second, FEP tubing with a confluent layer of endothelial cells on the vessel lumen. Instantaneous wall shear stress (WSS), time-averaged WSS, and oscillatory shear index were computed from velocity field measurements and compared between cases. The flow patterns and resulting wall shear were quantitatively determined to not accurately reproduce physiological flow, and that the Poiseuille flow assumption was found to be invalid. This work concludes that analysis of cell response to hemodynamic parameters using such bioreactors should be accompanied by corresponding flow measurements for accurate quantification of fluid stresses.

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A Porcine Model of Carotid Artery Thrombosis for Thrombolytic Therapy and Angioplasty: Application of PTFE Graft-Induced Stenosis

Abstract: This carotid artery thrombosis model, which incorporates intimal injury with segmental stenosis, is simple to create and reproducible. It provides not only a model for the evaluation of thrombolytic therapy but also a practical training tool for adjunctive endovascular interventions.

Cited by 5 publications

References 19 publications

Pulsed High–Intensity-focused US and Tissue Plasminogen Activator (TPA) Versus TPA Alone for Thrombolysis of Occluded Bypass Graft in Swine

Pulsed High–Intensity-focused US and Tissue Plasminogen Activator (TPA) Versus TPA Alone for Thrombolysis of Occluded Bypass Graft in Swine

The role of simulation in the development of endovascular surgical skills

Wall Shear Stress Measurements in an Arterial Flow Bioreactor

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