scholarly journals Construction of an in vivo carotid siphon model for testing endovascular devices for neuro-interventions

2017 ◽  
Vol 23 (3) ◽  
pp. 325-329
Author(s):  
Bu-Lang Gao ◽  
Yong-Li Wang ◽  
Xue-Jing Zhang ◽  
Qiong-Ying Fan ◽  
Wei-Li Hao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Glass Tube ◽  
Covered Stent ◽  
Covered Stents ◽  
Carotid Siphon ◽  
Endovascular Interventions ◽  
Pass Through ◽  
Endovascular Devices ◽  
Human Carotid

Objective The aim of this study was to construct an in vivo carotid siphon model for testing neurovascular devices for endovascular interventions. Methods A model of a human carotid siphon was pre-shaped using a glass tube from a human cadaver and used to confine a segment of one side of the common carotid artery (CCA) in canines. This segment of CCA with the glass carotid siphon on was interposed end-to-end onto the contralateral CCA so as to simulate a human carotid artery siphon in vivo. Two weeks later, the siphon model was evaluated using computed tomography angiography and digital subtraction angiography, and the covered stent specially designed for intracranial vasculature was navigated through the siphon model for a longitudinal flexibility test. Results All dogs tolerated the procedures well, and the artificial siphon model in vivo provided realistic conditions for device testing. Two weeks later, the in vivo carotid siphon model remained patent with no thrombosis. Five covered stents were navigated to pass through five siphon models successfully, with vasospasm occurring in two siphons. Conclusion Construction of an in vivo siphon model in dogs with a glass tube is feasible and useful for the test of endovascular devices for treating neurovascular diseases.

Surgical construction of a novel simulated carotid siphon in dogs

2008 ◽  
Vol 109 (6) ◽  
pp. 1173-1178 ◽  
Author(s):  
Hua-Qiao Tan ◽  
Ming-Hua Li ◽  
Yue-Qi Zhu ◽  
Chun Fang ◽  
Chun-Geng Wu ◽  
...  
Keyword(s):  
Covered Stents ◽  
Carotid Siphon ◽  
The Mean ◽  
The Right ◽  
Mean Time ◽  
Common Carotid Arteries ◽  
Endovascular Devices ◽  
Intracranial Vasculature

Object The development and preclinical assessment of new endovascular devices necessitate readily available and reproducible animal models. The purpose of this study was to develop an in vivo carotid siphon model for testing the properties of covered stents specially designed for the intracranial vasculature. Methods Six carotid siphon–shaped devices were created. Six dogs underwent surgery to expose and isolate both common carotid arteries (CCAs). The right CCA origin was ligated and incised distal to the ligation point after temporary constriction of the distal right CCA. The distal left CCA was ligated and incised proximal to the ligation point after the left CCA origin was temporarily clamped. The proximal isolated left CCA was passed through the shaped device and then anastomosed end-to-end to the distal isolated right CCA. Finally, the shaped device was fixed and embedded in the neck. Intraarterial digital subtraction angiography was performed at 7 days, 2 weeks, and 1 month postprocedure. All models underwent endovascular interventional simulation. The carotid siphon models were evaluated. Results The animals tolerated the surgical procedure well. The mean time for surgical construction of the model was 90 minutes. The morphology and endovascular manipulation of the siphon models were similar to those in humans. Stenosis of anastomotic stoma occurred in 2 models, and mural thrombosis of anastomotic stoma occurred in 1 model; however, all models were patent at postprocedural follow-up angiography. Conclusions Surgical construction of an in vivo carotid siphon model in dogs with carotid siphon–shaped devices is feasible and potentially useful for testing neurovascular devices.

scholarly journals Arterial stiffness identification of the human carotid artery using the stress–strain relationship in vivo

Ultrasonics ◽  
2012 ◽  
Vol 52 (3) ◽  
pp. 402-411 ◽  
Author(s):  
T. Khamdaeng ◽  
J. Luo ◽  
J. Vappou ◽  
P. Terdtoon ◽  
E.E. Konofagou
Keyword(s):  
Carotid Artery ◽  
Arterial Stiffness ◽  
Stress Strain ◽  
Stiffness Identification ◽  
Strain Relationship ◽  
Human Carotid

scholarly journals VEGF-targeted multispectral optoacoustic tomography and fluorescence molecular imaging in human carotid atherosclerotic plaques

2021 ◽  
Author(s):  
Pieter J. Steinkamp ◽  
Jasper Vonk ◽  
Lydian A. Huisman ◽  
Gert-Jan Meersma ◽  
Gilles F.H. Diercks ◽  
...  
Keyword(s):  
Molecular Imaging ◽  
Carotid Artery ◽  
Ex Vivo ◽  
Carotid Plaques ◽  
Symptomatic Carotid ◽  
Optoacoustic Tomography ◽  
Imaging Results ◽  
Human Carotid ◽  
Fluorescence Molecular Imaging

Abstract Background: Vulnerable atherosclerotic carotid plaques are prone to rupture resulting in ischemic strokes. Molecular imaging techniques have the potential to assess plaque vulnerability by visualizing molecular markers. Bevacizumab-800CW is a near-infrared fluorescent contrast agent antibody targeting vascular endothelial growth factor-A (VEGF-A). Here, we study if administration of bevacizumab-800CW is safe and can be visualized using multispectral optoacoustic tomography (MSOT) to evaluate atherosclerotic carotid plaques in vivo by visualizing intra-plaque neovascularization.Methods: Healthy volunteers were imaged with MSOT to determine the technical feasibility of human carotid imaging with MSOT. Patients with symptomatic carotid artery stenosis scheduled for carotid artery endarterectomy were intravenously administered with a bolus injection of 4.5 mg bevacizumab-800CW. Before and two days after tracer administration, in vivo non-invasive MSOT was performed. For validation, ex vivo fluorescence molecular imaging of the surgically removed plaque specimen was performed and correlated with histopathology.Results: Administration of 4.5 mg bevacizumab-800CW was safe in five patients. MSOT achieved accurate visualization of the carotid bifurcation area and assessment of the plaque in all five patients. Bevacizumab-800CW-resolved signal could not be detected with MSOT prior to surgery. However, ex vivo analysis of the carotid plaque showed accumulation of bevacizumab-800CW.Conclusions: These first-in-human MSOT and fluorescence molecular imaging results in carotid artery plaques suggest that bevacizumab is a potential tracer for imaging of vulnerable plaques. However, the microdose used here cannot be detected with MSOT. A subsequent phase I dose-finding study is needed to evaluate bevacizumab-800CW in higher doses as a useful optoacoustic imaging agent. Moreover, the development of dedicated optoacoustic contrast agents for signal attenuation of the targeting moiety is advisable for carotid atherosclerotic plaque assessment using MSOT.

Percutaneous Management of Concomitant Post-Traumatic High Vertebrovertebral and Caroticojugular Fistulas Using Balloons, Coils, and a Covered Stent

2003 ◽  
Vol 10 (5) ◽  
pp. 882-886 ◽  
Author(s):  
Ian C. Duncan ◽  
Pieter A. Fourie
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Covered Stent ◽  
Covered Stents ◽  
Extracranial Internal Carotid Artery ◽  
Arteriovenous Fistulas ◽  
Post Traumatic ◽  
Flow Through ◽  
The Right ◽  
Knife Injury

Purpose: To describe the endovascular management of vertebrovertebral and caroticojugular fistulas in the same patient using a combination of endovascular techniques including covered stent placement in the high extracranial internal carotid artery. Case Report: A 22-year-old man presented with ipsilateral vertebrovertebral and caroticojugular fistulas at the C1 level several weeks after sustaining a solitary penetrating knife injury below the right ear. The right vertebral artery was sacrificed after a failed endovascular attempt to close the vertebrovertebral fistula. The caroticojugular fistula was treated with a self-expanding covered stent (Wallgraft) with exclusion of the fistula and preservation of flow through the carotid artery. Conclusions: Preservation of the extracranial arteries should be the preferred goal of treatment in traumatic extracranial arteriovenous fistulas. The use of covered stents in the extracranial vessels can accomplish this goal.

scholarly journals Treatment of a Traumatic Carotid-Cavernous Fistula with a Covered Stent: Some Considerations

2009 ◽  
Vol 15 (2) ◽  
pp. 191-196 ◽  
Author(s):  
F.J.A. Meijer ◽  
A.M. Van Der Vliet
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Covered Stent ◽  
Balloon Occlusion ◽  
Covered Stents ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Limited Experience ◽  
Coil Occlusion ◽  
Direct Carotid Cavernous Fistula

This article discusses some considerations concerning covered stent placement in a patient with a traumatic direct carotid-cavernous fistula. Our case supports recent reports in the literature that covered stent placement can be an acceptable alternative when detachable balloon occlusion or coil occlusion of a direct carotid-cavernous fistula fails or cannot be done. Positioning of a covered stent in the internal carotid artery can be technically challenging. No specific covered stents for neurovascular use have been designed or registered. Because of limited experience with covered stent placement in the carotid artery the optimal preventive and therapeutic strategies for thromboembolic complications are not known.

scholarly journals Choice of In Vivo Versus Idealized Velocity Boundary Conditions Influences Physiologically Relevant Flow Patterns in a Subject-Specific Simulation of Flow in the Human Carotid Bifurcation

2008 ◽  
Vol 131 (2) ◽  
Author(s):  
Amanda K. Wake ◽  
John N. Oshinski ◽  
Allen R. Tannenbaum ◽  
Don P. Giddens
Keyword(s):  
Carotid Artery ◽  
Boundary Conditions ◽  
Carotid Bifurcation ◽  
Flow Patterns ◽  
Flow Data ◽  
Measured Velocity ◽  
Carotid Artery Bifurcation ◽  
Subject Specific ◽  
Human Carotid

Accurate fluid mechanics models are important tools for predicting the flow field in the carotid artery bifurcation and for understanding the relationship between hemodynamics and the initiation and progression of atherosclerosis. Clinical imaging modalities can be used to obtain geometry and blood flow data for developing subject-specific human carotid artery bifurcation models. We developed subject-specific computational fluid dynamics models of the human carotid bifurcation from magnetic resonance (MR) geometry data and phase contrast MR velocity data measured in vivo. Two simulations were conducted with identical geometry, flow rates, and fluid parameters: (1) Simulation 1 used in vivo measured velocity distributions as time-varying boundary conditions and (2) Simulation 2 used idealized fully-developed velocity profiles as boundary conditions. The position and extent of negative axial velocity regions (NAVRs) vary between the two simulations at any given point in time, and these regions vary temporally within each simulation. The combination of inlet velocity boundary conditions, geometry, and flow waveforms influences NAVRs. In particular, the combination of flow division and the location of the velocity peak with respect to individual carotid geometry landmarks (bifurcation apex position and the departure angle of the internal carotid) influences the size and location of these reversed flow zones. Average axial wall shear stress (WSS) distributions are qualitatively similar for the two simulations; however, instantaneous WSS values vary with the choice of velocity boundary conditions. By developing subject-specific simulations from in vivo measured geometry and flow data and varying the velocity boundary conditions in otherwise identical models, we isolated the effects of measured versus idealized velocity distributions on blood flow patterns. Choice of velocity distributions at boundary conditions is shown to influence pathophysiologically relevant flow patterns in the human carotid bifurcation. Although mean WSS distributions are qualitatively similar for measured and idealized inlet boundary conditions, instantaneous NAVRs differ and warrant imposing in vivo velocity boundary conditions in computational simulations. A simulation based on in vivo measured velocity distributions is preferred for modeling hemodynamics in subject-specific carotid artery bifurcation models when studying atherosclerosis initiation and development.

scholarly journals Jostent covered stent placement for emergency reconstruction of a ruptured internal carotid artery during or after transsphenoidal surgery

2015 ◽  
Vol 122 (5) ◽  
pp. 1223-1228 ◽  
Author(s):  
Byung Moon Kim ◽  
Pyoung Jeon ◽  
Dong Joon Kim ◽  
Dong Ik Kim ◽  
Sang Hyun Suh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Covered Stent ◽  
Active Bleeding ◽  
Covered Stents ◽  
Surgical Suture

OBJECT Internal carotid artery (ICA) rupture during transsphenoidal surgery (TSS) is an extremely difficult complication to treat. This study aimed to evaluate the immediate and long-term outcomes of covered stent placement for emergency reconstruction of ruptured ICAs during or after TSS. METHODS Seven patients underwent covered stent placement for emergency reconstruction of a ruptured ICA during or after TSS. The safety and effectiveness of covered stent placement for emergency reconstruction of ruptured ICAs were retrospectively analyzed. RESULTS Pretreatment angiography showed active bleeding in 6 patients (5 intraoperative and 1 postoperative) and a pseudoaneurysm in 1 patient. Of the 6 patients with active bleeding, 5 were treated with a successive operation to control active bleeding. The other patient was treated just after cardiopulmonary resuscitation due to massive nasal bleeding 20 days after revision of TSS. All active bleeding was controlled immediately after covered stent insertion in these 6 patients. One patient showed a gap between the covered stent and ICA wall without active bleeding 30 minutes after glycoprotein IIb/IIIa inhibitor administration due to in-stent thrombosis. The gap was occluded with coil embolization after completion of the temporarily suspended TSS. The seventh patient, whose ICA tear was treated with surgical suture, underwent covered stent placement for a pseudoaneurysm detected on postoperative Day 2. During a mean follow-up period of 46 months (range 12–85 months), all patients had excellent outcomes (modified Rankin Scale score of 0). All the stented ICAs were patent on vascular imaging follow-up at a mean of 34 months (range 12–85 months). CONCLUSIONS Covered stents appear to be a safe and effective option for emergency reconstruction of ruptured ICAs during or after TSS.

Covered Stents for the Prevention and Treatment of Carotid Blowout Syndrome

Neurosurgery ◽  
2015 ◽  
Vol 77 (2) ◽  
pp. 164-167 ◽  
Author(s):  
Brandon G. Gaynor ◽  
Diogo C. Haussen ◽  
Sudheer Ambekar ◽  
Eric C. Peterson ◽  
Dileep R. Yavagal ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Head And Neck ◽  
Perioperative Complications ◽  
Covered Stent ◽  
Covered Stents ◽  
Head And Neck Malignancy ◽  
Presenting Symptoms ◽  
Carotid Blowout Syndrome ◽  
Neck Malignancy ◽  
Ischemic Complications

Abstract BACKGROUND: Carotid blowout syndrome (CBS) is a life-threatening emergency resulting from compromise of the carotid artery caused by malignancy in the head and neck. OBJECTIVE: To report our experience with covered stents for the prevention or treatment of carotid blowout syndrome secondary to head and neck cancer to ascertain the safety and efficacy of this technique. METHODS: We reviewed the characteristics and outcome of all patients who underwent covered stent placement in the extracranial carotid artery in the setting of head and neck malignancy between 2006 and 2013 at the University of Miami. Patient demographics, presenting symptoms, devices used, perioperative complications, imaging, and follow-up data were reviewed. RESULTS: Seventeen carotids in 15 patients, whose ages ranged from 20 to 84 years (mean, 70.4 years), were treated with 20 covered nitinol (Viabahn Endoprosthesis, Gore, Flagstaff, Arizona) stents. Three patients were treated acutely for bleeding from carotid blowout, and 12 were treated prophylactically for threatened carotid blowout. All patients were given periprocedural dual antiplatelet therapy. No thromboembolic or ischemic complications were noted. Hemorrhage after treatment occurred in 4 patients. In 2 patients, the hemorrhage was from a source not covered by the stent. CONCLUSION: The use of covered stents is a simple, safe, and effective method for treating or preventing carotid blowout syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice.

Sign in / Sign up

Export Citation Format

Share Document