A canine model of mechanical thrombectomy in stroke
A canine model of mechanical thrombectomy in stroke
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DOI：
10.1136/neurintsurg-2019-014969
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发表时间：
2019-12-01
影响因子：
4.8
通讯作者：
Gounis, Matthew J.
中科院分区：
文献类型：
--
作者：
Brooks, Olivia W.;King, Robert M.;Gounis, Matthew J.
目的建立机械取栓治疗脑卒中大血管闭塞的临床前模型。材料与方法采用自体血凝块植入大脑中动脉建立脑缺血模型。在脑缺血（TICI） 2b/3再灌注中溶栓，将微导管引导至血栓，支架取栓。在血栓放置后和取栓后进行灌注和扩散MRI，以监测受限扩散的进展以及机械取栓后缺血的变化。死后进行组织学检查以确认中动脉区域梗死体积。结果在所有6只进入研究的猎犬中均记录了伴有tici0血流的初始MCA闭塞。6只动物中有4只（67%）在一次取栓通过后实现了TICI 2b/3血运重建。术中事件包括导致自发血运重建的血块自溶（n=1）和未解决的血管痉挛（n=1）导致取栓失败。在一个病例中，在微导管导航过程中的医源性创伤导致海绵状颈动脉水平的直接动静脉瘘。MRI分析表明，在取栓后的再灌注中，有一定体积的初始灌注缺损组织得以保留，在MRI和最终再通之间也有一定体积的梗死组织。结论我们描述了一种可以进行机械取栓的大型动物脑卒中模型。该模型可以促进，在临床前设置，优化复杂的多模式脑卒中治疗范例的临床翻译。
Purpose To develop a preclinical model of stroke with a large vessel occlusion treated with mechanical thrombectomy. Materials and methods An ischemic stroke model was created in dogs by the introduction of an autologous clot into the middle cerebral artery (MCA). A microcatheter was navigated to the clot and a stent retriever thrombectomy was performed with the goal to achieve Thrombolysis in Cerebral Ischemia (TICI) 2b/3 reperfusion. Perfusion and diffusion MRI was acquired after clot placement and following thrombectomy to monitor the progression of restricted diffusion as well as changes in ischemia as a result of mechanical thrombectomy. Post-mortem histology was done to confirm MCA territory infarct volume. Results Initial MCA occlusion with TICI 0 flow was documented in all six hound-cross dogs entered into the study. TICI 2b/3 revascularization was achieved with one thrombectomy pass in four of six animals (67%). Intra-procedural events including clot autolysis leading to spontaneous revascularization (n=1) and unresolved vasospasm (n=1) accounted for thrombectomy failure. In one case, iatrogenic trauma during microcatheter navigation resulted in a direct arteriovenous fistula at the level of the cavernous carotid. Analysis of MRI indicated that a volume of tissue from the initial perfusion deficit was spared with reperfusion following thrombectomy, and there was also a volume of tissue that infarcted between MRI and ultimate recanalization. Conclusion We describe a large animal stroke model in which mechanical thrombectomy can be performed. This model may facilitate, in a preclinical setting, optimization of complex multimodal stroke treatment paradigms for clinical translation.