title: Development of a new catheter prototype for laser thrombolysis under guidance of optical coherence tomography (OCT): validation of feasibility and efficacy in a preclinical model.
abstract: 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 mm2(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 mm2(p < 0.0001). In the alteplase + laser group, thrombus size decreased significantly (0.051 ± 0.026 g; p < 0.0001; 9.622 ± 0.582 mm2; 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.
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany. rouven.berndt@uksh.de.
authors.forename: Rouven
authors.initials: R
authors.lastname: Berndt
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany.
authors.forename: Rene
authors.initials: R
authors.lastname: Rusch
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care, University of Schleswig-Holstein, Kiel, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Hummitzsch
authors.affiliation: Department of Cardiology, University of Schleswig-Holstein, Kiel, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lutz
authors.affiliation: Institute of Neuropathology, University Hospital Münster, Münster, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Heß
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Huenges
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Panholzer
authors.affiliation: Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Otte
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany.
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Lutter
authors.affiliation: Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schlaefer
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Arnold-Heller-Str. 3, Hs 18, D-24105, Kiel, Germany.
authors.forename: Justus
authors.initials: J
authors.lastname: Groß
mesh_terms: D057785:Catheters / Q000592:standards*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D053685:Laser Therapy; D061185:Mechanical Thrombolysis / Q000379:methods*; D008954:Models, Biological; D015203:Reproducibility of Results; D013927:Thrombosis / Q000473:pathology / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D041623:Tomography, Optical Coherence / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Endovascular therapy; Laser; OCT; Thrombolysis; Thrombosis