Stroke Microsurgical Thrombectomy Human Placenta Simulator

• Published in: World neurosurgery Vol. 148; pp. e115 - e120
• Main Authors: de Oliveira, Marcelo Magaldi Ribeiro, Nicolato, Arthur, Malheiros, Jose Augusto, Vieira Costa, Pollyana Helena, Fidelis, Ana Clara, Tibães Oliveira, Maria Angélica, Ramos, Taise Mosso, Lima Junior, Geraldo Muzzi, Avellar, Leonardo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2021
• Subjects: Acute thrombus; Embolectomy; Microsurgery; Stroke; Surgical simulation; Thrombectomy; OCT; Thrombectomy; Stroke; EVT; MT; Microsurgery; HP; Surgical simulation; Acute thrombus; Embolectomy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2020.12.177

Stroke 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. Human placenta (HP) models simulated middle cerebral artery vessels with intraluminal thrombus to be microsurgically 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 through construct validity compared time to complete the task, complete vessel cleaning, vessel manipulation, vessel stenosis, and leakage in both techniques. All 6 HP models 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. A HP simulator can reproduce with high fidelity all stroke microsurgical thrombectomy part tasks. Transverse 1-mm arteriotomy followed by thrombectomy and 2 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 microsuture.