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Trotman-Lucas M, Gibson CL. A review of experimental models of focal cerebral ischemia focusing on the middle cerebral artery occlusion model. F1000Res 2021; 10:242. [PMID: 34046164 PMCID: PMC8127011 DOI: 10.12688/f1000research.51752.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
Cerebral ischemic stroke is a leading cause of death and disability, but current pharmacological therapies are limited in their utility and effectiveness.
In vitro and
in vivo models of ischemic stroke have been developed which allow us to further elucidate the pathophysiological mechanisms of injury and investigate potential drug targets.
In vitro models permit mechanistic investigation of the biochemical and molecular mechanisms of injury but are reductionist and do not mimic the complexity of clinical stroke.
In vivo models of ischemic stroke directly replicate the reduction in blood flow and the resulting impact on nervous tissue. The most frequently used
in vivo model of ischemic stroke is the intraluminal suture middle cerebral artery occlusion (iMCAO) model, which has been fundamental in revealing various aspects of stroke pathology. However, the iMCAO model produces lesion volumes with large standard deviations even though rigid surgical and data collection protocols are followed. There is a need to refine the MCAO model to reduce variability in the standard outcome measure of lesion volume. The typical approach to produce vessel occlusion is to induce an obstruction at the origin of the middle cerebral artery and reperfusion is reliant on the Circle of Willis (CoW). However, in rodents the CoW is anatomically highly variable which could account for variations in lesion volume. Thus, we developed a refined approach whereby reliance on the CoW for reperfusion was removed. This approach improved reperfusion to the ischemic hemisphere, reduced variability in lesion volume by 30%, and reduced group sizes required to determine an effective treatment response by almost 40%. This refinement involves a methodological adaptation of the original surgical approach which we have shared with the scientific community via publication of a visualised methods article and providing hands-on training to other experimental stroke researchers.
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Affiliation(s)
| | - Claire L Gibson
- School of Psychology, University of Nottingham, Nottingham, NG7 2UH, UK
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Trotman-Lucas M, Wong R, Allan SM, Gibson CL. Improved reperfusion following alternative surgical approach for experimental stroke in mice. F1000Res 2020; 9:188. [PMID: 32477496 PMCID: PMC7217225 DOI: 10.12688/f1000research.22594.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 03/29/2024] Open
Abstract
Background: Following ischemic stroke, recanalisation and restoration of blood flow to the affected area of the brain is critical and directly correlates with patient recovery. In vivo models of ischemic stroke show high variability in outcomes, which may be due to variability in reperfusion. We previously reported that a surgical refinement in the middle cerebral artery occlusion (MCAO) model of stroke, via repair of the common carotid artery (CCA), removes the reliance on the Circle of Willis for reperfusion and reduced infarct variability. Here we further assess this refined surgical approach on reperfusion characteristics following transient MCAO in mice. Methods: Mice underwent 60 min of MCAO, followed by either CCA repair or ligation at reperfusion. All mice underwent laser speckle contrast imaging at baseline, 24 h and 48 h post-MCAO. Results: CCA ligation reduced cerebral perfusion in the ipsilateral hemisphere compared to baseline (102.3 ± 4.57%) at 24 h (85.13 ± 16.09%; P < 0.01) and 48 h (75.04 ± 12.954%; P < 0.001) post-MCAO. Repair of the CCA returned perfusion to baseline (94.152 ± 2.44%) levels and perfusion was significantly improved compared to CCA ligation at both 24 h (102.83 ± 8.41%; P < 0.05) and 48 h (102.13 ± 9.34%; P < 0.001) post-MCAO. Conclusions: Our findings show CCA repair, an alternative surgical approach for MCAO, results in improved ischemic hemisphere perfusion during the acute phase.
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Affiliation(s)
| | - Raymond Wong
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stuart M. Allan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Claire L. Gibson
- School of Psychology, University of Nottingham, Nottingham, NG7 2UH, UK
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Trotman-Lucas M, Wong R, Allan SM, Gibson CL. Improved reperfusion following alternative surgical approach for experimental stroke in mice. F1000Res 2020; 9:188. [PMID: 32477496 PMCID: PMC7217225 DOI: 10.12688/f1000research.22594.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 03/29/2024] Open
Abstract
Background: Following ischemic stroke, recanalisation and restoration of blood flow to the affected area of the brain is critical and directly correlates with patient recovery. In vivo models of ischemic stroke show high variability in outcomes, which may be due to variability in reperfusion. We previously reported that a surgical refinement in the middle cerebral artery occlusion (MCAO) model of stroke, via repair of the common carotid artery (CCA), removes the reliance on the Circle of Willis for reperfusion and reduced infarct variability. Here we further assess this refined surgical approach on reperfusion characteristics following transient MCAO in mice. Methods: Mice underwent 60 min of MCAO, followed by either CCA repair or ligation at reperfusion. All mice underwent laser speckle contrast imaging at baseline, 24 h and 48 h post-MCAO. Results: CCA ligation reduced cerebral perfusion in the ipsilateral hemisphere compared to baseline (102.3 ± 4.57%) at 24 h (85.13 ± 16.09%; P < 0.01) and 48 h (75.04 ± 12.954%; P < 0.001) post-MCAO. Repair of the CCA returned perfusion to baseline (94.152 ± 2.44%) levels and perfusion was significantly improved compared to CCA ligation at both 24 h (102.83 ± 8.41%; P < 0.05) and 48 h (102.13 ± 9.34%; P < 0.001) post-MCAO. Conclusions: Our findings show CCA repair, an alternative surgical approach for MCAO, results in improved ischemic hemisphere perfusion during the acute phase.
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Affiliation(s)
| | - Raymond Wong
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stuart M. Allan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Claire L. Gibson
- School of Psychology, University of Nottingham, Nottingham, NG7 2UH, UK
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Trotman-Lucas M, Wong R, Allan SM, Gibson CL. Improved reperfusion following alternative surgical approach for experimental stroke in mice. F1000Res 2020; 9:188. [PMID: 32477496 PMCID: PMC7217225 DOI: 10.12688/f1000research.22594.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Following ischemic stroke, recanalisation and restoration of blood flow to the affected area of the brain is critical and directly correlates with patient recovery. In vivo models of ischemic stroke show high variability in outcomes, which may be due to variability in reperfusion. We previously reported that a surgical refinement in the middle cerebral artery occlusion (MCAO) model of stroke, via repair of the common carotid artery (CCA), removes the reliance on the Circle of Willis for reperfusion and reduced infarct variability. Here we further assess this refined surgical approach on reperfusion characteristics following transient MCAO in mice. Methods: Mice underwent 60 min of MCAO, followed by either CCA repair or ligation at reperfusion. All mice underwent laser speckle contrast imaging at baseline, 24 h and 48 h post-MCAO. Results: CCA ligation reduced cerebral perfusion in the ipsilateral hemisphere compared to baseline (102.3 ± 4.57%) at 24 h (85.13 ± 16.09%; P < 0.01) and 48 h (75.04 ± 12.954%; P < 0.001) post-MCAO. Repair of the CCA returned perfusion to baseline (94.152 ± 2.44%) levels and perfusion was significantly improved compared to CCA ligation at both 24 h (102.83 ± 8.41%; P < 0.05) and 48 h (102.13 ± 9.34%; P < 0.001) post-MCAO. Conclusions: Our findings show CCA repair, an alternative surgical approach for MCAO, results in improved ischemic hemisphere perfusion during the acute phase.
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Affiliation(s)
| | - Raymond Wong
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stuart M. Allan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Claire L. Gibson
- School of Psychology, University of Nottingham, Nottingham, NG7 2UH, UK
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Langer S, Schildhauer TA, Dudda M, Sauber J, Spindler N. Fibrin glue as a protective tool for microanastomoses in limb reconstructive surgery. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 4:Doc14. [PMID: 26759762 PMCID: PMC4709928 DOI: 10.3205/iprs000073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: Fibrin glue becomes a more and more routinely used tool for stabilization of microanastomoses and nerve repair. This paper summarizes the technical properties and advantages of its use in a wide variety of microsurgical contexts, and includes an exemplary limb reconstructive case. Patients and methods: A total of 131 patients who had undergone elective and emergency microsurgery mainly of the limbs were retrospectively analyzed, as was the use of free flaps. Results: The use of fibrin glue allows for proper positioning of anastomoses and repaired nerves. No torsion of the pedicle could be seen. The flap survival rated >94%. The fibrin glue could stay in place in >99%. In the rare case of revision, the fibrin glue could easily be removed without damaging the region of the microanastomosis. Conclusion: Fibrin glue should not be used to repair insufficient, i.e., leaking anastomoses, but it does protect the site of anastomosis from tissue and fluid pressure. It prevents the pedickle from torsion and its use facilitates relocation of the microanastomoses in cases of revision surgery.
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Affiliation(s)
- Stefan Langer
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | - Thomas A Schildhauer
- Department of Trauma, University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Marcel Dudda
- Department of Trauma, University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Jeannine Sauber
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | - Nick Spindler
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
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Rajiv S, Rodgers S, Bassiouni A, Vreugde S, Wormald PJ. Role of crushed skeletal muscle extract in hemostasis. Int Forum Allergy Rhinol 2015; 5:431-4. [DOI: 10.1002/alr.21489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/13/2014] [Accepted: 12/23/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Sukanya Rajiv
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Susan Rodgers
- Department of Haematology; SA Pathology; Adelaide Australia
| | - Ahmed Bassiouni
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
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Hill JW, Nemoto EM. Transient middle cerebral artery occlusion with complete reperfusion in spontaneously hypertensive rats. MethodsX 2014; 1:283-291. [PMID: 25632378 PMCID: PMC4306192 DOI: 10.1016/j.mex.2014.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Middle cerebral artery occlusion (MCAO) by the intraluminal suture method is widely used to model ischemic stroke in rats. Current methods include transection or ligation of the external carotid or common carotid artery and thus result in partial restoration of perfusion after transient MCAO. Since incomplete reperfusion may influence recovery and thus confound studies of the impact of neuroprotective compounds and therapies on outcomes after stroke, we have devised a novel method to induce transient MCAO with complete reperfusion. Advantages of the method include: MCAO is achieved through insertion of an intraluminal suture into the internal carotid artery through the common carotid artery.At the end of the occlusion period, the suture is withdrawn and the incision in the common carotid artery is closed with cyanoacrylate tissue adhesive and complete reperfusion is established.No residual subcutaneous sutures remain during recovery.Vasculature is restored to the preoperative state.
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Affiliation(s)
- Jeff W Hill
- University of New Mexico Health Sciences Center, Department of Neurosurgery, Albuquerque, New Mexico, 87131
| | - Edwin M Nemoto
- University of New Mexico Health Sciences Center, Department of Neurosurgery, Albuquerque, New Mexico, 87131
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Menovsky T, de Vries J, Grotenhuis JA. Cotton-clipping technique: piece of smashed muscle as an alternative. Neurosurgery 2011; 69:E1183-5; author reply E1185. [PMID: 21796006 DOI: 10.1227/neu.0b013e31822ed4b4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Akelina Y, Danilo P. Endogenous adipose tissue as a hemostatic: use in microsurgery. Microsurgery 2008; 28:192-6. [PMID: 18286653 DOI: 10.1002/micr.20452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bleeding is a frequent complication of microsurgical repair of small blood vessels and time is spent while hemostasis is accomplished. We studied the hemostatic effect of endogenous adipose tissue on bleeding from rat femoral arterial anastomoses. We measured bleeding time (time from removal of clamps to cessation of active bleeding) and mean arterial blood velocity (using a micro-Doppler system), the latter immediately after anastomosis, and again 7 days post-anastomosis. Bleeding time for vessels with fat applied to the artery was 50% less than when no fat was applied. Blood velocity by day 7 post-anastomosis returned to values equivalent to those for intact arteries. Histological evaluation of the anastomotic site demonstrated no significant differences in inflammatory response between fat-treated and untreated arteries. These data suggest that endogenous adipose tissue may be a useful hemostatic agent devoid of significant effects on small artery blood velocity or histology.
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Affiliation(s)
- Yelena Akelina
- Department of Orthopedics, College of Physicians & Surgeons of Columbia University, New York, NY 10032, USA.
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Dittmar MS, Vatankhah B, Fehm NP, Retzl G, Schuierer G, Bogdahn U, Schlachetzki F, Horn M. The role of ECA transection in the development of masticatory lesions in the MCAO filament model. Exp Neurol 2005; 195:372-8. [PMID: 16023640 DOI: 10.1016/j.expneurol.2005.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 05/18/2005] [Accepted: 05/21/2005] [Indexed: 10/25/2022]
Abstract
In the intraluminal suture model of middle cerebral artery occlusion (MCAO) in the rat, lesions of the masticator muscles associated with impaired functional outcome occur. We evaluated the role of external carotid artery (ECA) transection. We assessed whether isolated interruption of an arterial or a venous connection to the ECA territory was sufficient to induce masticatory hypoperfusion and lesions. We also evaluated a direct access to the common carotid artery (CCA) with subsequent vascular closure with regard to its feasibility, frequency of masticatory lesions, complications, and cerebral ischemia. Cerebral and masticatory lesions and perfusion deficits were assessed by in vivo magnetic resonance imaging (MRI). Vessel patency was evaluated using computerized tomography angiography and histology. An interruption of arterial blood flow led to masticatory hypoperfusion. Masticatory lesions occurred in 6% of the rats. Access to and closure of the CCA were feasible in all animals, leading to moderate or severe vessel stenosis in 20%, and intraarterial thrombosis in 25% of the rats. Reproducible cerebral infarctions were obtained in all animals. In 24% of the rats, hyperintense MRI signal changes were observed in the ipsilateral temporal muscle. Thus, the induction of masticatory hypoperfusion and lesions by arterial transection supports the role of the ECA in this context. Direct access to the CCA with subsequent vessel closure led to stenosis in most animals. Preservation of ECA continuity was not suitable to fully prevent masticatory lesions.
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Affiliation(s)
- Michael S Dittmar
- Department of Anesthesiology, University of Regensburg, 93042 Regensburg, Germany.
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