Human “live cadaver” neurovascular model for proximal and distal mechanical thrombectomy in stroke

Larco, Jorge Arturo; Madhani, Sarosh Irfan; Liu, Yang; Abbasi, Mehdi; Shahid, Adnan Hussain; Mereuta, Oana Madalina; Kadirvel, Ramanathan; Cloft, Harry J.; Kallmes, David F.; Brinjikji, Waleed; Savastano, Luis

doi:10.1136/neurintsurg-2022-018686

Cited by 3 publications

(1 citation statement)

References 27 publications

(35 reference statements)

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“…After institutional approval (IHCUC – institutional review board 20–0 02 582), three fresh never frozen human heads (two MMAs per specimen, n=6) were harvested, processed, and catheterized as previously described 9. Then, under roadmap visualization (Artis Z system Siemens Healthcare, Forchheim, Germany) a 5 F Berenstein catheter (Merit) was advanced over a glidewire into the distal internal maxillary artery (IMAX).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of an in vivo preclinical model for human middle meningeal artery embolization using the posterior intercostal artery of the swine

Larco

Madhani

Liu

et al. 2022

J NeuroIntervent Surg

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BackgroundEmbolization of the middle meningeal artery (MMA) is a promising minimally invasive technique that is gaining traction in the treatment of chronic subdural hematoma. Unfortunately, the human meninges and associated arteries are significantly larger than those of conventional laboratory animals, making the development of a clinically relevant animal model for testing of embolization agents elusive.ObjectiveTo introduce the posterior intercostal artery (PIA) model in swine and provide anatomical, angiographic, histological, and procedural data to validate its relevance in modeling the human MMA.MethodsIn human cadaveric specimens, 3D angiograms of the internal maxillary arteries (n=6) were obtained and the dura with MMA were harvested and histologically processed. Angiographic and histologic data of the human MMA were compared with the swine PIA (three animals). Then, embolization of the PIA (n=48 arteries) was conducted with liquid embolization agent (Onyx, Medtronic), and angiographic and histological results were assessed acutely (four animals) and after 30 days (two animals).ResultsThe human MMA has equivalent diameter, length, branching pattern, 3D trajectory, and wall structure to those of swine PIAs. Each swine has 12 to 14 PIAs (6–7 per side) suitable for acute or chronic embolization, which can be performed with high fidelity using the same devices, agents, and techniques currently used to embolize the MMA. The arterial wall structure and the acute and chronic histological findings in PIAs after embolization are comparable to those of humans.ConclusionsThis PIA model in swine could be used for research and development; objective benchmarking of agents, devices, and techniques; and in the training of neurointerventionalists.

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Section: Methodsmentioning

confidence: 99%

Evaluation of an in vivo preclinical model for human middle meningeal artery embolization using the posterior intercostal artery of the swine

Larco

Madhani

Liu

et al. 2022

J NeuroIntervent Surg

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Evaluation of vessel injury after simulated catheter use in an endothelialized silicone model of the intracranial arteries

et al. 2023

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Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers

Gorrell

Sawatsky

Edwards

2022

Journal of Manual & Manipulative Therapy

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Background: The vertebral artery (VA) may be stretched and subsequently damaged during manual cervical spine manipulation. The objective of this study was to measure VA length changes that occur during cervical spine manipulation and to compare these to the VA failure length. Methods: Piezoelectric ultrasound crystals were implanted along the length of the VA (C1 to C7) and were used to measure length changes during cervical spine manipulation of seven un-embalmed, post-rigor human cadavers. Arteries were then excised, and elongation from arbitrary in-situ head/neck positions to first force (0.1 N) was measured. Following this, VA were stretched (8.33 mm/s) to mechanical failure. Failure was defined as the instance when VA elongation resulted in a decrease in force. Results: From arbitrary in-situ head/neck positions, the greatest average VA length change during spinal manipulation was [mean (range)] 5.1% (1.1 to 15.1%). From arbitrary in-situ head/neck positions, arteries were elongated on average 33.5% (4.6 to 84.6%) prior to first force occurrence and 51.3% (16.3 to 105.1%) to failure. Average failure forces were 3.4 N (1.4 to 9.7 N). Conclusions: Measured in arbitrary in-situ head/neck positions, VA were slack. It appears that this slack must be taken up prior to VA experiencing tensile force. During cervical spine manipulations (using cervical spine extension and rotation), arterial length changes remained below that slack length, suggesting that VA elongated but were not stretched during the manipulation. However, in order to answer the question if cervical spine manipulation is safe from a mechanical perspective, the testing performed here needs to be repeated using a defined in-situ head/neck position and take into consideration other structures (e.g. carotid arteries).

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Human “live cadaver” neurovascular model for proximal and distal mechanical thrombectomy in stroke

Cited by 3 publications

References 27 publications

Evaluation of an in vivo preclinical model for human middle meningeal artery embolization using the posterior intercostal artery of the swine

Evaluation of an in vivo preclinical model for human middle meningeal artery embolization using the posterior intercostal artery of the swine

Evaluation of vessel injury after simulated catheter use in an endothelialized silicone model of the intracranial arteries

Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers

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