NeVaTM支架回收器的临床前评价:在猪血栓切除模型中的安全性和有效性。

Q1 Medicine Interventional Neurology Pub Date : 2018-04-01 Epub Date: 2018-02-13 DOI:10.1159/000486288
Arthur J Ulm, Tigran Khachatryan, Arthur Grigorian, Raul G Nogueira
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引用次数: 12

摘要

背景:一种新型支架回收装置,具有增强的径向力轮廓,扩大的偏置开口,和一个封闭的远端已经开发。目的:评价NeVaTM取栓装置在血栓闭塞性疾病动物模型中的安全性和有效性。材料和方法:用7头猪进行安全性和有效性研究。采用4种栓子形态建立血栓闭塞性疾病模型;2种不同的自体全血血栓、血浆富集血栓和Onyx®栓子模型。使用不同大小的栓子进行了35例血管闭塞和取出。记录改良脑缺血溶栓前后(mTICI)评分、取栓次数和血管造影并发症的出现情况。在安全性研究中,共完成了6次血块取出,并对血管区域进行了粗略检查,并进行了组织病理学评估。进行半定量血管痉挛研究。在NeVaTM和控制装置上进行径向力测试进行比较。结果:34/35例闭塞患者平均1.2次后达到接近完全或完全再灌注(mTICI 2b/3)。17/17的全血凝块(范围在10 - 20mm之间)在平均1.06次通过后达到完全再灌注(tici3)。Onyx®和富血浆凝块栓塞的mTICI 2b/3再灌注率分别为10/11(平均1.6次)和5/5(平均1.0次)。组织病理学血管损伤和血管痉挛评分与谓词研究相当。径向力曲线显示,与谓词装置相比,膨胀径向力增加,压缩径向力相似。结论:我们的临床前结果支持在临床试验中使用NeVaTM装置,以确定这种新设计是否能改善当前支架回收器的效果。
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Preclinical Evaluation of the NeVaTM Stent Retriever: Safety and Efficacy in the Swine Thrombectomy Model.

Background: A novel stent retriever device with an enhanced radial force profile, enlarged offset openings, and a closed distal end has been developed.

Objective: Evaluate the safety and effectiveness of the NeVaTM thrombectomy device in animal model of thrombo-occlusive disease.

Materials and methods: Seven swine were used in safety and efficacy studies. Thrombo-occlusive disease was modeled using 4 emboli morphologies; 2 distinct models of autologous whole blood thrombi, plasma-enriched thrombi, and Onyx® emboli. A total of 35 vascular occlusions and retrievals were performed using emboli of variable sizes. Pre- and post-modified thrombolysis in cerebral ischemia (mTICI) scores, number of retrievals, and the presence of angiographic complications were recorded. In the safety study, a total of 6 clot retrievals were completed and the vascular territory examined grossly and harvested for histopathological evaluation. A semiquantitative vasospasm study was performed. Radial force testing was performed on NeVaTM and control devices for comparison.

Results: Near-full or full reperfusion (mTICI 2b/3) was achieved in 34/35 occlusions after a mean of 1.2 passes. Full reperfusion (TICI 3) was achieved in 17/17 of whole blood clot occlusions (ranging between 10 and 20 mm) after a mean of 1.06 passes. The rate of mTICI 2b/3 reperfusion was 10/11 (mean, 1.6 passes) and 5/5 (mean, 1.0 passes) for Onyx® and plasma-enriched clot emboli, respectively. Histopathological vessel injury and vasospasm scores were comparable to predicate studies. Radial force curves demonstrated increased expansive radial force and similar compressive radial force compared to predicate devices.

Conclusions: Our preclinical results support the use of the NeVaTM device in a clinical trial to determine if this novel design improves upon current stent retriever outcomes.

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Interventional Neurology
Interventional Neurology CLINICAL NEUROLOGY-
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