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Journal of Neurosurgical Sciences 2015 Apr 24

lingua: Inglese

Experimental in-vivo model of intravascular shunting for neurosurgical by-pass

Riva M. 1, Beretta S. 1, Carone D. 1, Pappada' G. B. 1, Bruneau M. 2, Giussani C. 1, Paterno' G. 1, Versace A. 1, Ferrarese C. 1, Sganzerla E. 1

1 Laboratory of Experimental Stroke Research, DCMT, University of Milano Bicocca, Monza, Italy;
2 Department of Neurosurgery, Erasme Hospital, University of Brussels, Belgium


AIM: Excessively long clamping time and suboptimal position of stitches can influence the anastomosis patency and the clinical outcome in cerebral by-­pass surgery. Coronary intravascular micro-­shunts could represent an innovative solution for neurosurgical by-­pass, but the hemodynamic properties of these devices should be extensively studied before their translational application. We created an experimental in-­vivo model and we analyzed the blood flow and pressure modification induced by the micro-shunt.
METHODS: After laparotomy, an intravascular micro-­shunt was placed into the aorta of 8 adult rats, simulating a neurosurgical setting in which the shunt is temporary placed inside the receiving cerebral vessel. A fiber-­optic pressure sensor was placed in the femoral artery and the blood pressure continuously recorded during the procedure. Using an ultrasound vascular probe, blood flow velocity in aorta was measured at baseline and both proximally and distally to the shunt.
RESULTS: After shunt positioning, no significant decrease in blood pressure was observed (mean value 68.57 versus 80.00 mmHg; p=0.48). Distal aortic blood flow, expressed as peak systolic velocity, showed a significant decrease after shunt positioning (mean value 51.88 versus 86.88 cm/sec; p=0.04), with a mean residual blood flow of 63%. Blood flow values recorded immediately upstream to the shunt did not differ from baseline.
CONCLUSION: This is the first in-­vivo experimental study concerning the hemodynamic properties of an intravascular micro­shunt. Our results demonstrate that this device provides a considerable blood out-­flow without significant changes in blood pressure, suggesting that specific neurosurgical micro-­shunts might be developed.

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