A rabbit model for efficacy evaluation of endovascular coil materials

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Presentation transcript:

A rabbit model for efficacy evaluation of endovascular coil materials Masaki Ebara, MD, Ichiro Yuki, MD, Yuichi Murayama, MD, Takayuki Saguchi, MD, Yih-Lin Nien, MD, Harry V. Vinters, MD, Fernando Vinuela, MD, Toshiaki Abe, MD  Surgical Neurology  Volume 72, Issue 6, Pages 620-627 (December 2009) DOI: 10.1016/j.surneu.2009.04.017 Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 1 A schematic view of the operative procedure (exposure of the artery): in supine position (A), the right side of the CCA is exposed and temporary clamp was placed (B). SH indicates sternohyoid Muscle; CC, cutaneous colli muscle; SM, sternomastoid muscle; C, vessel clip. Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 2 A schematic view of the operative procedure (catheter insertion): a permanent ligature was placed on the distal side of the CCA with 4-0 proline (A). The CCA was punctured with a 22-G Angiocath at 3 mm proximal to the distal ligation and the catheter was advanced into the CCA cavity in a retrograde fashion (B). Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 3 A schematic view of the operative procedure (implantation): a 2cm of straightened coil material was inserted via the catheter (A). An additional ligation was placed at 2 mm proximal side of the puncture site using a 4-0 proline. The implanted material was also fixed in the vessel by the ligation, leaving approximately 4 mm of distal end of the material outside of the vessel (B). The latter procedure was intended to prevent the bleeding from the puncture site as well as to stabilize the position of the implanted material and to prevent its migration into the proximal side of the artery. M indicates material; L, ligation. Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 4 A microscopic image of an arterial section 14 days after the implantation of a PLGA coil (original magnification ×40). Thickness measurement of organized thrombus around the implant was measured. The arrows indicate the 4 different measuring points. If a sample shows that the organized thrombus around the implant was attached to the arterial wall, the distance between the material surface and the intimal layer of the arterial wall was measured (arrow W). The asterisk indicates the center of the implanted material. Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 5 Postimplantation angiography. A PLGA coil was implanted in the left CCA and a bare platinum coil in the right (arrows indicate implanted materials). Injected contrast media slowly extended toward the distal part of each arterial segment. Contrast stagnation was observed proximal side of each arterial segment. No significant intermaterial difference was observed. Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 6 Microscopic view of a cross section of CCA implanted with PLGA coil (A) and bare platinum coil (B) at postimplantation day 7 (hematoxylin and eosin, original magnification ×40). Implanted materials were surrounded by immature thrombus. Development of the organized thrombus around the both material types remained minimal, and comparative analysis between the materials was not performed at this time point (bar = 100 μm). Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 7 Microscopic view of a cross section of CCA implanted with PLGA coil (A) and bare platinum coil (B) at postimplantation day 14 (hematoxylin and eosin). Transverse section of CCA implanted with a Matrix coil (A: original magnification ×40) and a GDC (B: original magnification ×40) are presented. Matrix coil–implanted samples developed significant organized thrombus around the material, whereas the GDC-implanted samples showed the less amount of it. Higher magnification of Matrix-implanted sample showed organized thrombus with abundant lymphocytes invasions and accumulated spindle-shaped cells adjacent to the material (C: original magnification ×100; bar = 100 μm). Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 8 Microscopic views of a cross section of CCA implanted with PLGA coil (A) and bare platinum coil (B) at postimplantation day 30. Both PLGA coil–implanted samples (A) and bare platinum coil–implanted samples (B) showed notable thrombus organization around the coil materials, and the lumen of the artery was filled with proliferated tissue. However, the thickness of organized thrombus around the 2 material types was not significantly different (P = .12). Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 9 Intermaterial comparison of the thickness of organized thrombus around materials; intermaterial comparison of thrombus organization around the material was performed. Y-axis indicates the mean thickness of organized thrombus around the implanted material. X-axis indicates the materials and their different harvesting times. At days 10 and 14, organized tissue surrounding the material was significantly thicker in Matrix coil–implanted group than those in the GDC group (⁎P = .051 at day 10, ⁎⁎P = .011 at day 14). At day 30, no statistical significance between the 2 material types was shown (⁎⁎⁎ P = .12). Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions

Fig. 10 The preliminary results of several polymeric suture materials implanted in the animal model (day 14). A: Microscopic view of a cross section of CCA implanted with Monocryl (75% PGA/25% ɛ-caprolactone) (hematoxylin and eosin, original magnification ×40). Implanted material is surrounded by thick organized thrombus (arrow). B: 25/75 PLGA implanted in the animal model induced relatively less advanced thrombus organization around the material. Immature thrombus with aggregated red blood cells is surrounding the coil-thrombus complex (hematoxylin and eosin, original magnification ×40). C: Polysorb (10% polyglycolic acid/90% polylactic acid with coating of glycolide and ɛ-caprolactone) was evaluated in the animal model. Remarkable thrombus organization around the implanted material as well as circumferential intimal hyperplasia was observed (hematoxylin and eosin, original magnification ×40). Surgical Neurology 2009 72, 620-627DOI: (10.1016/j.surneu.2009.04.017) Copyright © 2009 Elsevier Inc. Terms and Conditions