Stroke Microsurgical Thrombectomy Human Placenta Simulator.

Abstract

OBJECTIVE\nStroke microsurgical cerebrovascular thrombectomy reports are limited although this technique could be used in many centers as a primary treatment or a salvage intervention option. It requires great ability, so our aim is to describe and validate a stroke microsurgical thrombectomy ex vivo simulator with operative nuances analysis.\n\n\nMETHODS\nHuman placenta (HP) models simulated middle cerebral artery vessels with intra-luminal thrombus to be micro-surgically excised. Six neurosurgeons` performed 1 mm and 2 mm longitudinal and transverse arteriotomy in different arteries to remove a 1.5 cm length thrombus. Validation trhough construct validity compared time to complete the task, complete vessel cleaning, vessel manipulation, vessel stenosis and leakage in both techniques.\n\n\nRESULTS\nAll 6 HP reproduced with fidelity stroke microsurgical thrombectomy so participants completed 24 sessions, 4 for each neurosurgeon on the same model in different arteries. Construct validity highlighted microsurgical technical difficulties with positive results obtained by parameters variation during performance. Transverse arteriotomy with 1 mm length had best results (p<0.05) allowing complete thrombus removal, less stenosis and minor leakage in abbreviated time.\n\n\nCONCLUSIONS\nHP simulator can reproduce with high fidelity all stroke microsurgical thrombectomy part tasks. Transverse 1 mm arteriotomy followed by thrombectomy and two simple sutures can fulfill all quality assurance aspects in such intervention accordingly to training model, due to easier vessel opening, complete thrombus removal, no stenosis and faster micro-suture.