组织爆破法促进猪脑出血模型中的血凝块液化。
Histotripsy Clot Liquefaction in a Porcine Intracerebral Hemorrhage Model.
机构信息
Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
出版信息
Neurosurgery. 2020 Mar 1;86(3):429-436. doi: 10.1093/neuros/nyz089.
BACKGROUND
Intracerebral hemorrhage (ICH) is characterized by a 30-d mortality rate of 40% and significant disability for those who survive.
OBJECTIVE
To investigate the initial safety concerns of histotripsy mediated clot liquefaction and aspiration in a porcine ICH model. Histotripsy is a noninvasive, focused ultrasound technique that generates cavitation to mechanically fractionate tissue. Histotripsy has the potential to liquefy clot in the brain and facilitate minimally invasive aspiration.
METHODS
About 1.75-mL clots were formed in the frontal lobe of the brain (n = 18; n = 6/group). The centers of the clots were liquefied with histotripsy 48 h after formation, and the content was either evacuated or left within the brain. A control group was left untreated. Pigs underwent magnetic resonance imaging (MRI) 7 to 8 d after clot formation and were subsequently euthanized. Neurological behavior was assessed throughout. Histological analysis was performed on harvested brains. A subset of pigs underwent acute analysis (≤6 h).
RESULTS
Histotripsy was able to liquefy the center of clots without direct damage to the perihematomal brain tissue. An average volume of 0.9 ± 0.5 mL was drained after histotripsy treatment. All groups showed mild ischemia and gliosis in the perihematomal region; however, there were no deaths or signs of neurological dysfunction in any groups.
CONCLUSION
This study presents the first analysis of histotripsy-based liquefaction of ICH in vivo. Histotripsy safely liquefies clots without significant additional damage to the perihematomal region. The liquefied content of the clot can be easily evacuated, and the undrained clot has no effect on pig survival or neurological behavior.
背景
脑出血 (ICH) 的 30 天死亡率为 40%，幸存者也会出现严重残疾。
目的
在猪 ICH 模型中，研究组织粉碎介导的血栓液化和抽吸的初始安全性问题。组织粉碎是一种非侵入性的聚焦超声技术，可产生空化作用使组织机械性碎裂。组织粉碎有可能使脑中的血栓液化并促进微创抽吸。
方法
在大脑额叶形成约 1.75 毫升的血栓（n=18；n=6/组）。形成后 48 小时，使用组织粉碎技术将血栓中心液化，内容物被抽吸出来或留在脑内。一组对照组未作处理。猪在血栓形成后 7 至 8 天接受磁共振成像 (MRI) 检查，随后安乐死。整个过程中进行神经行为评估。对取出的大脑进行组织学分析。一部分猪接受急性分析（≤6 小时）。
结果
组织粉碎能够液化血栓的中心而不会对血肿周围脑组织造成直接损伤。组织粉碎治疗后平均排出 0.9±0.5 毫升的体积。所有组在血肿周围区域均表现出轻度缺血和神经胶质增生；然而，任何组均未出现死亡或神经功能障碍的迹象。
结论
本研究首次分析了组织粉碎在体内治疗 ICH 的效果。组织粉碎安全地液化了血栓，而对血肿周围区域无明显额外损伤。血栓的液化内容物可以轻易排出，未排出的血栓对猪的存活或神经行为无影响。
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