Berndt Rouven, Rusch Rene, Hummitzsch Lars, Lutz Matthias, Heß Katharina, Huenges Katharina, Panholzer Bernd, Otte Christoph, Haneya Assad, Lutter Georg, Schlaefer Alexander, Cremer Jochen, Groß Justus
Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany.
Department of Anesthesiology and Surgical Intensive Care, University of Schleswig-Holstein, Kiel, Germany.
J Thromb Thrombolysis. 2017 Apr;43(3):352-360. doi: 10.1007/s11239-016-1470-0.
In this feasibility study, a novel catheter prototype for laser thrombolysis under the guidance of optical coherence tomography (OCT) was designed and evaluated in a preclinical model. Human arteries and veins were integrated into a physiological flow model and occluded with thrombi made from the Chandler Loop. There were four experimental groups: placebo, 20 mg alteplase, laser, 20 mg alteplase + laser. The extent of thrombolysis was analyzed by weighing, OCT imaging and relative thrombus size. In the alteplase group, thrombus size decreased to 0.250 ± 0.036 g (p < 0.0001) and 14.495 ± 0.526 mm (p < 0.0001) at 60 min. The relative thrombus size decreased to 73.6 ± 4.1% at 60 min (p < 0.0001). In the laser group, thrombus size decreased significantly to 0.145 ± 0.028 g (p < 0.0001) and 11.559 ± 1.034 mm (p < 0.0001). In the alteplase + laser group, thrombus size decreased significantly (0.051 ± 0.026 g; p < 0.0001; 9.622 ± 0.582 mm; p < 0.0001; 47.4 ± 6.1%; p < 0.0001) in contrast to sole alteplase and laser application. The reproducibility and accuracy of the OCT imaging was high (SD <10%). Histological examination showed no relevant destruction of the vascular layers after laser ablation (arteries: 745.8 ± 5.5 μm; p = 0.69; veins: 448.3 ± 4.5 μm; p = 0.27). Thus, laser ablation and OCT imaging are feasible with the novel catheter and thrombolysis combining alteplase with laser irradiation appears highly efficient.
在这项可行性研究中，设计了一种用于在光学相干断层扫描（OCT）引导下进行激光溶栓的新型导管原型，并在临床前模型中进行了评估。将人体动脉和静脉整合到生理血流模型中，并用钱德勒环制成的血栓使其闭塞。有四个实验组：安慰剂组、20mg阿替普酶组、激光组、20mg阿替普酶+激光组。通过称重、OCT成像和相对血栓大小分析溶栓程度。在阿替普酶组中，60分钟时血栓大小降至0.250±0.036g（p<0.0001）和14.495±0.526mm（p<0.0001）。相对血栓大小在60分钟时降至73.6±4.1%（p<0.0001）。在激光组中，血栓大小显著降至0.145±0.028g（p<0.0001）和11.559±1.034mm（p<0.0001）。与单独使用阿替普酶和激光相比，在阿替普酶+激光组中，血栓大小显著降低（0.051±0.026g；p<0.0001；9.622±0.582mm；p<0.0001；47.4±6.1%；p<0.0001）。OCT成像的重现性和准确性很高（标准差<10%）。组织学检查显示激光消融后血管层无相关破坏（动脉：745.8±5.5μm；p=0.69；静脉：448.3±4.5μm；p=0.27）。因此，使用新型导管进行激光消融和OCT成像是可行的，并且将阿替普酶与激光照射相结合的溶栓似乎非常有效。
