Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique

Abstract

BackgroundRecent advances 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 an approach has not been demonstrated.ObjectiveTo evaluate the safety of a novel endovascular transmural approach to target the perivascular tissues of the common carotid artery in swine.MethodsA micro-infusion device was positioned in the carotid arteries of three Yorkshire pigs (six carotid arteries in total), and each carotid artery was punctured 10 times in the same location to gain access to the perivascular tissues. Digital subtraction angiography was used to evaluate vessel injury or contrast extravasation. MRI and MR angiography were used to evaluate evidence of cerebral ischemia or vessel injury. Post-mortem tissue analysis was performed to assess the level of extravascular hematoma and intravascular dissection.ResultsNone of the tested carotid arteries showed evidence of vessel injury (dissection or perforation) or intravascular thrombosis. MRI performed after 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.ConclusionRepeated 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.

Neurovascular Interventions for Neurotrauma: From Treatment of Injured Vessels to Treatment of the Injured Brain?

“…82 Accordingly, transvessel approaches were explored as potential future routes, showing that they can be applied within the central nervous system in the proof-of-concept study. 83 Important nuances in the neurovascular anatomy exist for a relatively thinner wall relative to the vessel caliber with pronounced internal elastica. Creation of a parenchymal microworking channel to the central nervous system in large animal models in the acute and chronic phases 84 demonstrated that the transvessel wall technique is applicable to brain intervention for delivery or sampling, showing no clinical or biochemical complications and a normal angiography appearance in the chronic phase.…”