Article Text

Original research
Evaluation of an in vivo preclinical model for human middle meningeal artery embolization using the posterior intercostal artery of the swine
  1. Jorge L Arturo Larco1,
  2. Sarosh Irfan Madhani1,
  3. Yang Liu2,
  4. Mehdi Abbasi3,
  5. Pedro N Lylyk4,
  6. Amy Benike3,
  7. Adnan Shahid1,
  8. Burak Tekin5,
  9. Reade Quinton5,
  10. Luis E Savastano1,6
  1. 1 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Global Institute of Future Technology, Shanghai Jiao Tong University, Shanghai, China
  3. 3 Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  4. 4 Department of Interventional Neuroradiology, Clinica Sagrada Familia, Buenos Aires, CABA, Argentina
  5. 5 Department of Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
  6. 6 Department of Neurosurgery, UCSF, San Francisco, California, USA
  1. Correspondence to Dr Luis E Savastano, Department of Neurosurgery, UCSF, San Francisco, CA 94143, USA; luis.savastano{at}


Background Embolization 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.

Objective To 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.

Methods In 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).

Results The 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.

Conclusions This PIA model in swine could be used for research and development; objective benchmarking of agents, devices, and techniques; and in the training of neurointerventionalists.

  • Subdural
  • Technique
  • Angiography
  • Artery
  • Intervention

Data availability statement

Data are available upon reasonable request. N/A.

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Data availability statement

Data are available upon reasonable request. N/A.

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  • Twitter @JLarco8, @MadhaniSarosh, @SavastanoLuisMD

  • JLAL and MA contributed equally.

  • Contributors JLAL and SIM contributed equally to this work. LES conceived the concept and designed the study. YL, MA, PNL performed data analysis and interpretation. JLAL, MA, BT, and RQ performed histology and interpretation. AB provided animal care as a certified veterinary technician. All the other authors provided a leading effort in collecting and preparing the specimens. The article was critically revised by all the authors. LES provided administrative, technical, supervisory, or other support. All authors reviewed the submitted version, and JLAL approved it on behalf of all the authors. JLAL, YL, and LES are guarantors of the integrity of the entire study.

  • Funding This research received moderate grants for the use of the model; Medtronic non-specific grant number.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.