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Original research
Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique
  1. Wi Jin Kim1,
  2. Hasitha Milan Samarage1,
  3. David Zarrin2,
  4. Keshav Goel2,
  5. Anthony C Wang1,
  6. Jeremiah Johnson1,
  7. Kambiz Nael3,
  8. Geoffrey P Colby1,3
  1. 1Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
  2. 2David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
  3. 3Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Geoffrey P Colby, Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; gcolby{at}mednet.ucla.edu

Abstract

Background Recent advances in endovascular devices have allowed access and targeting of perivascular tissues of the peripheral circulation. The perivascular tissues of the cervical and cranial circulations have many important structures of clinical significance, yet the feasibility and safety of such an approach has not been demonstrated.

Objective To evaluate the safety of a novel endovascular transmural approach to target the perivascular tissues of the common carotid artery in swine.

Methods A micro-infusion device was positioned in the carotid arteries of three Yorkshire pigs (six carotid arteries in total), and each carotid artery was punctured 10 times in the same location to gain access to the perivascular tissues. Digital subtraction angiography was used to evaluate vessel injury or contrast extravasation. MRI and MR angiography were used to evaluate evidence of cerebral ischemia or vessel injury. Post-mortem tissue analysis was performed to assess the level of extravascular hematoma and intravascular dissection.

Results None of the tested carotid arteries showed evidence of vessel injury (dissection or perforation) or intravascular thrombosis. MRI performed after repeated puncture was negative for neck hematoma and brain ischemia. Post-mortem tissue analysis of the carotid arteries showed mild adventitial staining with blood, but without associated hematoma and without vessel dissection.

Conclusion Repeated puncture of the carotid artery to gain access to the perivascular tissues using a novel endovascular transmural approach is safe in a swine model. This represents a novel approach to various tissues in close proximity to the cervical and cranial vasculature.

  • Cervical
  • Device
  • Neck
  • Technique
  • Vessel Wall

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors WJK, HMS, ACW, JJ, and GPC made substantial contributions to the concept and design of the work and the interpretation of the data for the work. WJK, HMS, DZ, KG, KN, and GPC made substantial contributions to the acquisition, analysis, and interpretation of the data for the work. All authors were significantly involved in drafting and revising the work. All authors reviewed and approved the final version of the work and agree to be accountable for aspects of the work. GPC is responsible for the overall content as the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding Casa Colina Foundation research grant, NIH Research Education Programs (R25).

  • 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.