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Original research
Human “live cadaver” neurovascular model for proximal and distal mechanical thrombectomy in stroke
  1. Jorge L Arturo Larco1,2,
  2. Sarosh Irfan Madhani1,
  3. Yang Liu1,2,
  4. Mehdi Abbasi2,
  5. Adnan H Shahid1,
  6. Oana Madalina Mereuta2,3,
  7. Ramanathan Kadirvel2,
  8. Harry J Cloft2,
  9. David F Kallmes2,
  10. Waleed Brinjikji1,2,
  11. Luis Savastano1,2
  1. 1Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Radiology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3CÚRAM–SFI Research Centre for Medical Devices and Physiology Department, National University of Ireland Galway, Galway, Ireland
  1. Correspondence to Dr Luis Savastano, Neurosurgery, Mayo Clinic Rochester, Rochester, MN 55905, USA; Savastano.luis{at}mayo.edu

Abstract

Background Preclinical testing platforms that accurately replicate complex human cerebral vasculature are critical to advance neurointerventional knowledge, tools, and techniques. Here, we introduced and validated a human “live cadaveric” head-and-neck neurovascular model optimized for proximal and distal vascular occlusion and recanalization techniques.

Methods Human cadaveric head-and-neck specimens were cannulated bilaterally in the jugular veins, carotid, and vertebral arteries. Specimens were then coupled with modular glass models of the aorta and extracranial carotid arteries, as well as radial and femoral access ports. Intracranial physiological flow was simulated using a flow-delivery system and blood-mimicking fluid. Baseline anatomy, histological, and mechanical properties of cerebral arteries were compared with those of fresh specimens. Radiopaque clot analogs were embolized to replicate proximal and distal arterial occlusions, followed by thrombectomy. Experienced interventionalists scored the model on different aspects.

Results Compared with counterpart fresh human arteries, formalin-fixed arteries showed similar mechanical properties, including maximum stretch, increased tensile strength/stiffness, and friction coefficients were also not significantly different. On histology, minimal endothelial damage was noted in arteries after 3 months of light fixation, otherwise the arterial wall maintained the structural integrity. Contrast angiographies showed no micro- or macro-vasculature obstruction. Proximal and distal occlusions created within the middle cerebral arteries were consistently obtained and successfully recanalized. Additionally, interventionists scored the model highly realistic, indicating great similarity to patients’ vasculature.

Conclusions The human “live cadaveric” neurovascular model accurately replicates the anatomy, mechanics, and hemodynamics of cerebral vasculature and allows the performance of neurointerventional procedures equivalent to those done in patients.

  • Stroke
  • Intervention
  • Thrombectomy
  • Technique
  • Navigation

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @MadhaniSarosh

  • JLAL and SIM contributed equally.

  • Contributors JLAL and SIM contributed equally to this work. JLAL, YL, and LS conceived the concept and JLAL, YL, and LS designed the study. YL and MA performed data analysis and interpretation. JLAL, MA, AHS, SIM, and OMM performed histology. All the other authors provided leading effort in collecting and preparing the specimens. JLAL and SIM drafted the article. The article was critically revised by YL, WB, HJC, DFK, and LS. WB, HJC, RK, DFK, and LS 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 LS are guarantors of the integrity of the entire study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.