Blizard Institute, The Faculty of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
Defence Endovascular Resuscitation Group, Research and Clinical Innovation, Birmingham, UK.
Scand J Trauma Resusc Emerg Med. 2023 Dec 12;31(1):97. doi: 10.1186/s13049-023-01148-z.
Selective aortic arch perfusion (SAAP) is a novel endovascular technique that combines thoracic aortic occlusion with extracorporeal perfusion of the brain and heart. SAAP may have a role in both haemorrhagic shock and in cardiac arrest due to coronary ischaemia. Despite promising animal studies, no data is available that describes SAAP in humans. The primary aim of this study was to assess the feasibility of selective aortic arch perfusion in humans. The secondary aim of the study was to assess the feasibility of achieving direct coronary artery access via the SAAP catheter as a potential conduit for salvage percutaneous coronary intervention.
Using perfused human cadavers, a prototype SAAP catheter was inserted into the descending aorta under fluoroscopic guidance via a standard femoral percutaneous access device. The catheter balloon was inflated and the aortic arch perfused with radio-opaque contrast. The coronary arteries were cannulated through the SAAP catheter.
The procedure was conducted four times. During the first two trials the SAAP catheter was passed rapidly and without incident to the intended descending aortic landing zone and aortic arch perfusion was successfully delivered via the device. The SAAP catheter balloon failed on the third trial. On the fourth trial the left coronary system was cannulated using a 5Fr coronary guiding catheter through the central SAAP catheter lumen.
For the first time using a perfused cadaveric model we have demonstrated that a SAAP catheter can be easily and safely inserted and SAAP can be achieved using conventional endovascular techniques. The SAAP catheter allowed successful access to the proximal aorta and permitted retrograde perfusion of the coronary and cerebral circulation.
选择性主动脉弓灌注（SAAP）是一种将胸主动脉阻断与脑和心脏体外灌注相结合的新型血管内技术。SAAP 在失血性休克和因冠状动脉缺血导致的心脏骤停中都可能具有作用。尽管动物研究结果很有前景，但目前尚无描述人类 SAAP 的数据。本研究的主要目的是评估人类选择性主动脉弓灌注的可行性。该研究的次要目的是评估通过 SAAP 导管直接进行冠状动脉进入的可行性，作为挽救性经皮冠状动脉介入治疗的潜在导管。
使用灌注的人体尸体，在透视引导下，通过标准股动脉经皮进入装置将原型 SAAP 导管插入降主动脉。导管球囊充气，并用不透射线的对比剂对主动脉弓进行灌注。通过 SAAP 导管对冠状动脉进行插管。
该程序进行了四次。在前两次试验中，SAAP 导管迅速且无意外地通过至预期的降主动脉着陆区，并且通过该装置成功地进行了主动脉弓灌注。第三次试验中 SAAP 导管球囊出现故障。第四次试验中，通过中央 SAAP 导管腔使用 5Fr 冠状动脉引导导管对左冠状动脉系统进行了插管。
我们首次使用灌注的尸体模型证明，SAAP 导管可以轻松且安全地插入，并且可以使用常规血管内技术实现 SAAP。SAAP 导管允许成功进入近端主动脉，并允许逆行灌注冠状动脉和脑循环。
