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A reproducible animal model of calcified atherosclerotic plaque exhibiting properties similar to those observed in the human population has proven difficult to develop. We therefore investigated the use of a bone marrow plug, placed interventionally in the coronary and peripheral arteries, to simulate the properties of a calcific chronic partial occlusion (CPO) lesion for the evaluation of catheter based technologies.
Forty-one pigs were prepped sterilely for creation of the CPO. An introducer sheath was placed in the carotid artery for vascular access. Angiograms of the left anterior descending (LAD) coronary artery and the iliac tree were obtained. A section of artery measuring 2.8 - 3.0mm in diameter was identified and targeted for implantation with the plug. A cylinder of bone marrow measuring 3mm in outer diameter by 10mm in length was obtained from the rib of a donor animal and a lumen measuring approximately 1.6mm in diameter was created. The bone plug was loaded into a 9Fr guide catheter, tracked to the targeted location within the artery and deployed. Angiography immediately post deployment demonstrated an average lesion lumen diameter of 1.32mm (1.08 - 2.35mm).
Twenty-nine of forty-one pigs (implanted with a total of thirty-five bone plugs) survived to the scheduled follow-up procedure (between 4 and 14 days). Thirty of the thirty-five surviving implanted bone plugs were patent, with follow-up angiography demonstrating reduced blood flow through the lesion, with an average lesion lumen diameter of 1.20mm (0 - 2.59mm).
We can reliably create a porcine coronary model simulating a calcific partial occlusion, which can be used for the evaluation of interventional technologies and platforms used to treat coronary and peripheral artery disease. The results of previous studies have demonstrated successful deployment of a chronic total occlusion (CTO) version of the bone plug in the coronary and peripheral vasculature. Additionally, we have successfully implanted larger bone marrow plugs (measuring 3.0 - 5.5mm in outer diameter) and demonstrated the ability to reduce the calcium content of the bone marrow plug prior to deployment, thereby decreasing the hardness of the lesion.
- 2013 American College of Cardiology Foundation