Biodegradable Magnesium Stent Treatment of Saccular Aneurysms in a Rat Model - Introduction of the Surgical Technique
Summary
Reproducable experimental animal models are needed for the testing of novel embolization materials, which have been designed to treat endovascular occlusion of intracranial aneurysms (IA). The present study aims to develop a safe and standardized surgical technique for stent assisted embolization of saccular aneurysms in a rat animal model.
Abstract
The steady progess in the armamentarium of techniques available for endovascular treatment of intracranial aneurysms requires affordable and reproducable experimental animal models to test novel embolization materials such as stents and flow diverters. The aim of the present project was to design a safe, fast, and standardized surgical technique for stent assisted embolization of saccular aneurysms in a rat animal model.
Saccular aneurysms were created from an arterial graft from the descending aorta.The aneurysms were microsurgically transplanted through end-to-side anastomosis to the infrarenal abdominal aorta of a syngenic male Wistar rat weighing >500 g. Following aneurysm anastomosis, aneurysm embolization was performed using balloon expandable magnesium stents (2.5 mm x 6 mm). The stent system was retrograde introduced from the lower abdominal aorta using a modified Seldinger technique.
Following a pilot series of 6 animals, a total of 67 rats were operated according to established standard operating procedures. Mean surgery time, mean anastomosis time, and mean suturing time of the artery puncture site were 167 ± 22 min, 26 ± 6 min and 11 ± 5 min, respectively. The mortality rate was 6% (n=4). The morbidity rate was 7.5% (n=5), and in-stent thrombosis was found in 4 cases (n=2 early, n=2 late in stent thrombosis).
The results demonstrate the feasibility of standardized stent occlusion of saccular sidewall aneurysms in rats – with low rates of morbidity and mortality. This stent embolization procedure combines the opportunity to study novel concepts of stent or flow diverter based devices as well as the molecular aspects of healing.
Introduction
Subarachnoid hemorrhage due to a ruptured intracranial aneurysm is associated with a high mortality rate and poor neurological outcome in many survivors. There are currently two general approaches to occlude IA: either microsurgical clipping (which requires operative exposure of the aneurysm), or endovascular occlusion. As the less invasive endovascular coil treatment of narrow-necked IA has been shown to be associated with slightly lower morbidity (especially in the posterior circulation1,2), endovascular treatment options have become the preferred modality of many neurosurgical centers. Numerous devices have been developed in order to extend the indications of endovascular treatment and overcome the main limitation of IA recurrence after coiling. Intracranial stents are especially promising to overcome these limitations, as they serve as a scaffold for neo-endothelization and coil herniation prevention, as well as protect the parent artery and improve intraluminal intraaneurysmal thrombosis caused by reduction of blood inflow. There is a need to study novel intracranial stents in a low cost animal model; at both macroscopic and molecular levels.
The aim of this study was to design a safe, fast, and standardized surgical technique for stent application in an already established saccular aneurysm model in rats3,4,5. In the present project, we evaluated the role of a biodegradable magnesium stent.
Protocol
Representative Results
Discussion
Bioabsorbable stents and animal models
In recent years the general trend in medicine has been away from permanent implants (which remain in the patient's body for the rest of their life) to bio-absorbable materials. Magnesium stents, in particular, are already quite established in cardiology8,9. Unfortunately these stents have not yet been tested for other applications, such as cerebrovascular diseases. For this reason we decided to stu…
Declarações
The authors have nothing to disclose.
Acknowledgements
We thank Eugen Hofmann and Philine Zumstein for their excellent technical assistance and for sharing their expertise in stent application procedures. We thank Majlinda Kalanderi for the anatomical drawing.
Materials
| Medetomidine | any generic | ||
| Ketamin | any generic | ||
| Buprenorphine | any generic | ||
| Phosphate buffered saline | |||
| Sodium dodecyl sulfate (0.1%) | |||
| 3-0 resorbable suture | Ethicon Inc., USA | VCP428G | |
| 5-0 non absorbable suture | Ethicon Inc., USA | 8618G | |
| 6-0 non-absorbable suture | B. Braun, Germany | C0766070 | |
| 9-0 non-absorbable suture | B. Braun, Germany | G1111140 | |
| 10-0 non-absorbable suture | Covidien, USA | N2530 Monosof | |
| Operation microscope | Zeiss, Germany | ||
| Digital microscope camera | Sony, Japan | HXR-MC1P | |
| Standard surgical instruments | multiple | see protocol 7.a | |
| Microsurgical instruments | multiple | see protocol 7.b | |
| Vascular clip applicator | B. Braun, Germany | FT495T | |
| Temporary vascular clamps | B. Braun, Germany | ||
| 19G Puncture needle | Angiomed GmbH, Germany | 15820010 | |
| Hydrophobic guide wire | Cook Medical, USA | G00650 | |
| 4F sheat | Cordis Corporation, USA | 504-604A | |
| Inflation syringe | |||
| Laboratory shaker | Stuart | SRT6 | |
| Magnesium Stent 2.5/6 AMS with Polymer coating | Biotronik, Switzerland | ||
| Surgery drape | |||
| Sterile cellulose swabs | |||
| Syringes 1 ml and 2 ml | |||
| Hollow needles 18G and 26G | |||
| Isotonic sodium chloride | |||
| Microtubes | |||
| Eye ointment | Bausch + Lomb Inc, USA | Lacrinorm | any generic |
| Small animal shaver |
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