背景:脑膜中动脉(MMA)栓塞是一种有前途的微创技术,在治疗慢性硬膜下血肿方面获得了广泛的关注。不幸的是,人类脑膜和相关动脉明显大于传统的实验动物,开发用于测试栓塞剂的临床相关动物模型难以捉摸。
目的:介绍猪肋间后动脉(PIA)模型,血管造影,组织学,和程序数据,以验证其在人类MMA建模中的相关性。
方法:在人类尸体标本中,获得了上颌内动脉的3D血管造影照片(n=6),并收获了具有MMA的硬脑膜并进行了组织学处理。将人MMA的血管造影和组织学数据与猪PIA(三只动物)进行比较。然后,用液体栓塞剂(Onyx,美敦力),急性(4只动物)和30天后(2只动物)评估血管造影和组织学结果。
结果:人类MMA具有等效直径,长度,分支模式,3D轨迹,和猪PIA的墙壁结构。每头猪有12至14个PIA(每侧6-7个)适合急性或慢性栓塞,可以使用相同的设备进行高保真,代理商,以及目前用于栓塞MMA的技术。栓塞后PIA的动脉壁结构以及急性和慢性组织学发现与人类相当。
结论:该猪PIA模型可用于研究和开发;药物的客观基准,设备,和技术;以及神经干预学家的培训。
BACKGROUND: Embolization of the middle meningeal artery (MMA) is a promising minimally invasive technique that is gaining traction in the treatment of chronic subdural hematoma. Unfortunately, the human meninges and associated arteries are significantly larger than those of conventional laboratory animals, making the development of a clinically relevant animal model for testing of embolization agents elusive.
OBJECTIVE: To introduce the posterior intercostal artery (PIA) model in swine and provide anatomical, angiographic, histological, and procedural data to validate its relevance in modeling the human MMA.
METHODS: In human cadaveric specimens, 3D angiograms of the internal maxillary arteries (n=6) were obtained and the dura with MMA were harvested and histologically processed. Angiographic and histologic data of the human MMA were compared with the swine PIA (three animals). Then, embolization of the PIA (n=48 arteries) was conducted with liquid embolization agent (Onyx, Medtronic), and angiographic and histological results were assessed acutely (four animals) and after 30 days (two animals).
RESULTS: The human MMA has equivalent diameter, length, branching pattern, 3D trajectory, and wall structure to those of swine PIAs. Each swine has 12 to 14 PIAs (6-7 per side) suitable for acute or chronic embolization, which can be performed with high fidelity using the same devices, agents, and techniques currently used to embolize the MMA. The arterial wall structure and the acute and chronic histological findings in PIAs after embolization are comparable to those of humans.
CONCLUSIONS: This PIA model in swine could be used for research and development; objective benchmarking of agents, devices, and techniques; and in the training of neurointerventionalists.