Resident University of California, Los Angeles Los Angeles, California, United States
Introduction: Recent advancement in endovascular devices have allowed access and targeting of perivascular tissues of the peripheral circulation. The perivascular tissues of the cervical and cranial circulations have many important structures of clinical significance, yet the feasibility and safety of such approach has not been demonstrated. We evaluate the safety of a novel endovascular transmural approach to target the perivascular tissues of the common carotid artery in swine.
Methods: A Micro-Infusion Device was positioned in the carotid arteries of 3 Yorkshire pigs (6 carotid arteries total), and each carotid artery was punctured ten times in the same location to gain access to the perivascular tissues. Digital subtraction angiography (DSA) was used to evaluate for vessel injury or contrast extravasation. Magnetic resonance imaging and angiography (MRI and MRA) was used to evaluate for evidence of cerebral ischemia or vessel injury. Post-mortem tissue analysis was performed to assess for extravascular hematoma and intravascular dissection.
Results: None of the tested carotid arteries demonstrated evidence of vessel injury (dissection or perforation) or intravascular thrombosis. MRI performed post repeated puncture was negative for neck hematoma and brain ischemia. Post-mortem tissue analysis of the carotid arteries showed mild adventitial staining with blood, but without associated hematoma and without vessel dissection.
Conclusion : Repeated puncture of the carotid artery to gain access to the perivascular tissues using a novel endovascular transmural approach is safe in a swine model. This represents a novel approach to various tissues in close proximity to the cervical and cranial vasculature.
