Transauricular embolization of the rabbit coronary artery for experimental myocardial infarction: comparison of a minimally invasive closed-chest model with open-chest surgery

<p>Abstract</p> <p>Introduction</p> <p>To date, most animal studies of myocardial ischemia have used open-chest models with direct surgical coronary artery ligation. We aimed to develop a novel, percutaneous, minimally-invasive, closed-chest model of experimental myocardial infarction (EMI) in the New Zealand White rabbit and compare it with the standard open-chest surgical model in order to minimize local and systemic side-effects of major surgery.</p> <p>Methods</p> <p>New Zealand White rabbits were handled in conformity with the "Guide for the Care and Use of Laboratory Animals" and underwent EMI under intravenous anesthesia. Group A underwent EMI with an open-chest method involving surgical tracheostomy, a mini median sternotomy incision and left anterior descending (LAD) coronary artery ligation with a plain suture, whereas Group B underwent EMI with a closed-chest method involving fluoroscopy-guided percutaneous transauricular intra-arterial access, superselective LAD catheterization and distal coronary embolization with a micro-coil. Electrocardiography (ECG), cardiac enzymes and transcatheter left ventricular end-diastolic pressure (LVEDP) measurements were recorded. Surviving animals were euthanized after 4 weeks and the hearts were harvested for Hematoxylin-eosin and Masson-trichrome staining.</p> <p>Results</p> <p>In total, 38 subjects underwent EMI with a surgical (n = 17) or endovascular (n = 21) approach. ST-segment elevation (1.90 ± 0.71 mm) occurred sharply after surgical LAD ligation compared to progressive ST elevation (2.01 ± 0.84 mm;p = 0.68) within 15-20 min after LAD micro-coil embolization. Increase of troponin and other cardiac enzymes, abnormal ischemic Q waves and LVEDP changes were recorded in both groups without any significant differences (p > 0.05). Infarct area was similar in both models (0.86 ± 0.35 cm in the surgical group vs. 0.92 ± 0.54 cm in the percutaneous group;p = 0.68).</p> <p>Conclusion</p> <p>The proposed model of transauricular coronary coil embolization avoids thoracotomy and major surgery and may be an equally reliable and reproducible platform for the experimental study of myocardial ischemia.</p

Below the knee angioplasty: bare versus drug-eluting stents

Abstract A 74-year-old patient suffering from critical limb ischaemia underwent percutaneous endovascular revascularization in the interventional radiology department. Baseline symptomatology included severe rest pain not responding to common analgesics, and dry gangrene of the left toe (Rutherford–Becker stage 5). The ankle-brachial index at presentation was 0.60. Selective digital subtraction angiography revealed significant 50–60% tortuous multiple stenoses and one near occlusion, all detected at the proximal segment of the peroneal artery which was the only patent infrapopliteal vessel. The arterial supply of the distal foot was preserved by the distal peroneal collateral network. Direct stenting of the diseased proximal peroneal segment using three sirolimus-eluting stents in an overlapping manner was performed. The total stented length was 94mm. Dual antiplatelet therapy was prescribed for 6 months, followed by monotherapy with clopidogrel 75mg 1 × 1. Complete wound healing and clinical improvement by three stages (Rutherford-Becker stage 2 from stage 5) was detected at one-year follow-up and was sustained throughout a three-year follow-up period. The lesion was patent without any in-stent restenosis at two years angiographic follow-up.</jats:p

Treatment of infrainguinal thromboembolic complications during peripheral endovascular procedures with AngioJet rheolytic thrombectomy, intraoperative thrombolysis, and selective stenting

ObjectiveThis study investigated the safety and effectiveness of the infrainguinal use of the AngioJet rheolytic mechanical thrombectomy system (Possis Medical, Minneapolis, Minn) for the treatment of acute infrainguinal thromboembolism occurring during lower limb revascularization procedures.MethodsFor the interval between January 2000 and January 2011, our hospital's database was meticulously searched for all patients with acute thromboembolism that occurred during lower limb angioplasty, with or without stenting procedures, who were treated with infrainguinal AngioJet thrombectomy. Baseline patient demographics and procedural details were analyzed. Primary end points included technical success, defined as the complete revascularization of the acutely occluded vessel; clinical success, defined as the absence of death or amputation ≤60 days; and procedure-related complication. Secondary end points included embolized vessel primary patency and overall patient survival.ResultsDuring this 12-year period, 3147 peripheral percutaneous procedures of angioplasty, with or without stenting, were performed in our department. Intraoperative, clinically, and angiographically evident thromboembolism occurred in 18 of 3147 procedures (0.57%), and 14 (77.7%) were managed using the AngioJet thrombectomy system. In total, 22 arteries were treated (13 infrapopliteal, 3 femoropopliteal, and 6 popliteal arteries). All patients had a completion angiogram for the assessment of the runoff vessels' status. Technical and clinical success occurred in 13 of 14 (92.8%). Adjunctive local thrombolysis or clot trapping, or both, with stenting was used in 64.3% and 42.8% of the procedures, respectively. Mean time follow-up was 38.1 ± 49.0 months. The 1-year embolized vessel primary patency rate was 50.9%, and the survival rate was 53.5% up to 11.5 years of follow-up, as estimated by Kaplan-Meier analysis. The 1-year limb salvage rate was 92.3%. There were no procedure-related minor amputations and one (7.1%) procedure-related major above-knee amputation.ConclusionsThe use of AngioJet rheolytic thrombectomy and adjunctive local thrombolysis or stenting, or both, under filter protection, is safe and effective for the management of severe thromboembolic complications occurring in the femoropopliteal and infrapopliteal arteries during peripheral endovascular procedures