Arteriel pose Mikrokirurgisk bifurkation Aneurisme Model i kaninen
Summary
Udvikling og test af endovaskulære anordninger til intrakraniel aneurismebehandling er stadig af stor betydning. De fleste aneurismemodeller, der anvendes i dag, savner enten de vigtige egenskaber ved en arteriel degenereret væg eller hæmodynamikken ved en ægte bifurcation. Derfor havde vi til formål at designe en ny arteriel pose bifurcation model hos kaniner.
Abstract
Endovaskulær behandling af intrakranielle aneurismer fik betydning i løbet af de sidste årtier, og der er derfor et øget behov for at teste endovaskulære enheder. Dyremodeller, der respekterer rheologiske, hæmodynamiske og aneurismevægsforhold, er meget berettigede. Derfor var formålet med denne undersøgelse at designe en ny standardiseret og reproducerbar kirurgisk teknik til at skabe autologe arterielle pose bifurcation aneurismer med ikke-modificerede og modificerede vægforhold hos kaniner.
Bifurcation aneurismer blev skabt ved ende-til-side anastomose til højre til venstre almindelig halspulsåre, begge tjener som forældrearterier til arteriel posen, som blev mikrokirurgisk syet på. Transplantater blev taget fra den proksimale højre almindelige halspulsåre, enten til kontrolgruppen (n = 7, øjeblikkelig autolog reimplantation) eller modificeret (n = 7, inkuberet med 100 internationale enheder elastase i 20 minutter før autolog reimplantation). Pose og forældrearteriepatency blev kontrolleret af fluorescensangiografi umiddelbart efter oprettelsen. Ved opfølgning (28 dage) gennemgik alle kaniner kontrastforstærket magnetisk resonansangiografi og fluorescensangiografi efterfulgt af aneurismehøst, makroskopisk og histologisk evaluering.
I alt 16 kvindelige newzealandske hvide kaniner blev opereret. To dyr døde for tidligt. Ved opfølgning forblev 85,72% af alle aneurismer patenterede. Begge grupper afslørede en stigning i aneurismestørrelse over tid; dette var mere udtalt i kontrolgruppen (6,48 ± 1,81 mm3 på oprettelsestidspunktet vs. 19,85 ± 6,40 mm3 ved opfølgning, p = 0,037) end i den modificerede gruppe (8,03 ± 1,08 mm3 på oprettelsestidspunktet vs. 20,29 ± 6,16 mm3 ved opfølgning, p = 0,054).
Vores resultater viser tilstrækkeligheden af denne nye kaninmodel, som giver mulighed for at skabe bifurcationsaneurismer med forskellige vægforhold i en mikrokirurgisk tilgang. I betragtning af den fremragende langsigtede patency og egenskaben af aneurismevækst over tid kan denne model tjene som et vigtigt redskab til præklinisk evaluering af nye endovaskulære terapier.
Introduction
Subarachnoid blødning som følge af intrakraniel aneurisme (IA) brud kan effektivt kontrolleres ved enten endovaskulær eller mikrokirurgisk okklusionsteknikker 1,2,3,4. Forskellige endovaskulære terapier, for at overvinde den største begrænsning af IA-gentagelse efter coiling, fik betydning i løbet af de sidste årtier, hvilket skabte et øget behov for test af endovaskulære enheder. For at teste disse nye behandlingsmetoder er passende dyremodeller, der respekterer reologiske egenskaber, hæmodynamik og aneurismevægsforhold, stærkt berettigede 5,6,7. I denne sammenhæng har kliniske såvel som prækliniske undersøgelser allerede afsløret den vigtige rolle, som aneurismevægstilstande spiller med hensyn til aneurismebrud og gentagelse efter okklusion, især med fokus på tab af vægmalericeller 7,8,9.
Hidtil er eksperimentelle aneurismer hos kaniner oftest blevet skabt enten ved elastase inkuberet almindelig halspulsåre (CCA) stubbe eller venøse poser sutureret i en kunstig CCA bifurcation. 10,11,12,13,14,15,16 Således er en ægte arteriel pose bifurcation model aldrig blevet beskrevet.
Formålet med denne undersøgelse var at designe en sikker, hurtig og standardiseret teknik til mikrokirurgisk oprettelse af bifurcationsaneurismer med forskellige vægforhold i en kaninmodel (figur 1). Dette blev opnået ved at suturere ikke-modificerede og modificerede arterielle poser i en kunstig skabt bifurcation af begge CCA’er.
Protocol
Representative Results
Discussion
Vores undersøgelse viser muligheden for at skabe en ægte bifurcation aneurisme model med forskellige vægforhold hos kaniner. Samlet set blev 14 kvindelige newzealandske hvide kaniner med en gennemsnitsvægt på 3,7 ± 0,09 kg og en gennemsnitsalder på 112 ± 3 dage inkluderet i undersøgelsen. 85,72% af alle aneurismer forblev patent under en opfølgning på 28 dage. To dyr døde for tidligt (12,5% dødelighed).
Tidligere undersøgelser foreslog en række ekstrakranielle aneurismemodeller …
Disclosures
The authors have nothing to disclose.
Acknowledgements
Forfatterne takker Olgica Beslac og Kay Nettelbeck for deres fremragende støtte og tekniske bistand i den perioperative fase og Alessandra Bergadano, DVM, ph.d., for det dedikerede tilsyn med den langsigtede dyresundhed.
Materials
| 3-0 resorbable suture | Ethicon Inc., USA | VCP428G | |
| 4-0 non-absorbable suture | B. Braun, Germany | G0762563 | |
| 6-0 non-absorbable suture | B. Braun, Germany | C0766070 | |
| 9-0 non-absorbable suture | B. Braun, Germany | G1111140 | |
| Adrenaline | Amino AG | 1445419 | any generic |
| Amiodarone | Helvepharm AG | 5078567 | any generic |
| Anesthesia machine | Dräger | any other | |
| Aspirin | Sanofi-Aventis (Suisse) SA | 622693 | any generic |
| Atropine | Labatec Pharma SA | 6577083 | any generic |
| Bandpass filter blue | Thorlabs | FD1B | any other |
| Bandpass filter green | Thorlabs | FGV9 | any other |
| Bipolar forceps | any other | ||
| Bicycle spotlight | any other | ||
| Biemer vessel clip (2 x) | B. Braun Medical AG, Aesculap, Switzerland | FD560R | temporary |
| Bispectral index (neonatal) | any other | ||
| Blood pressure cuff (neonatal) | any other | ||
| Clamoxyl | GlaxoSmithKline AG | 758808 | any generic |
| Dexmedetomidine | Ever Pharma | 136740-1 | any generic |
| Electrocardiogram electrodes | any other | ||
| Elastase | Sigma Aldrich | 45125 | any generic |
| Ephedrine | Amino AG | 1435734 | any generic |
| Esmolol | OrPha Swiss GmbH | 3284044 | any generic |
| Fentanyl (intravenous use) | Janssen-Cilag AG | 98683 | any generic |
| Fentanyl (transdermal) | Mepha Pharma AG | 4008286 | any generic |
| Fluoresceine | Curatis AG | 5030376 | any generic |
| Fragmin | Pfizer PFE Switzerland GmbH | 1906725 | any generic |
| Glyco | any generic | ||
| Heating pad | any other | ||
| Isotonic sodium chloride solution (0.9%) | Fresenius KABI | 336769 | any generic |
| Ketamine | Pfizer | 342261 | any generic |
| Laboratory shaker | Stuart | SRT6 | any other |
| Lidocaine | Streuli Pharma AG | 747466 | any generic |
| Longuettes | any other | ||
| Metacam | Boehringer Ingelheim | P7626406 | any generic |
| Methadone | Streuli Pharma AG | 1084546 | any generic |
| Microtubes | any other | ||
| Micro needle holder | any other | ||
| Midazolam | Accord Healthcare AG | 7752484 | any generic |
| Needle holder | any other | ||
| O2-Face mask | any other | ||
| Operation microscope | Wild Heerbrugg | any other | |
| Papaverine | Bichsel | any generic | |
| Prilocaine-lidocaine creme | Emla | any generic | |
| Propofol | B. Braun Medical AG, Switzerland | any generic | |
| Pulse oxymeter | any generic | ||
| Rectal temperature probe (neonatal) | any other | ||
| Ropivacaine | Aspen Pharma Schweiz GmbH | 1882249 | any generic |
| Scalpell | Swann-Morton | 210 | any other |
| Small animal shaver | any other | ||
| Smartphone | any other | ||
| Soft tissue forceps | any other | ||
| Soft tissue spreader | any other | ||
| Stainless steel sponge bowls | any other | ||
| Sterile micro swabs | any other | ||
| Stethoscope | any other | ||
| Straight and curved micro-forceps | any other | ||
| Straight and curved micro-scissors | any other | ||
| Straight and curved forceps | any other | ||
| Surgery drape | any other | ||
| Surgical scissors | any other | ||
| Syringes 1 ml, 2ml and 5 ml | any other | ||
| Tris-Buffer | Sigma Aldrich | 93302 | any generic |
| Vascular clip applicator | B. Braun, Germany | FT495T | |
| Vein and arterial catheter 22 G | any generic | ||
| Vitarubin | Streuli Pharma AG | 6847559 | any generic |
| Yasargil titan standard clip (2 x) | B. Braun Medical AG, Aesculap, Switzerland | FT242T | temporary |
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