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Rösch Y, Stolte T, Weisskopf M, Frey S, Schwartz R, Cesarovic N, Obrist D. Efficacy of catheter-based drug delivery in a hybrid in vitro model of cardiac microvascular obstruction with porcine microthrombi. Bioeng Transl Med 2024; 9:e10631. [PMID: 38435814 PMCID: PMC10905539 DOI: 10.1002/btm2.10631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/19/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024] Open
Abstract
Microvascular obstruction (MVO) often occurs in ST-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). Diagnosis and treatment of MVO lack appropriate and established procedures. This study focused on two major points by using an in vitro multiscale flow model, which comprised an aortic root model with physiological blood flow and a microfluidic model of the microcirculation with vessel diameters down to 50 μm. First, the influence of porcine microthrombi (MT), injected into the fluidic microchip, on perfusion was investigated. We found that only 43 % of all injected MT were fully occlusive. Second, it could also be shown that the maximal concentration of a dye (representing therapeutic agent) during intracoronary infusion could be increased on average by 58 % , when proximally occluding the coronary artery by a balloon during drug infusion. The obtained results and insights enhance the understanding of perfusion in MVO-affected microcirculation and could lead to improved treatment methods for MVO patients.
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Affiliation(s)
- Yannick Rösch
- ARTORG Center for Biomedical Engineering ResearchUniversity of BernBernSwitzerland
| | - Thorald Stolte
- Department of Health Science and TechnologyETH ZurichZurichSwitzerland
| | - Miriam Weisskopf
- Center for Preclinical DevelopmentUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | | | | | - Nikola Cesarovic
- Department of Health Science and TechnologyETH ZurichZurichSwitzerland
- Department of Cardiothoracic and Vascular SurgeryDeutsches Herzzentrum der Charité (DHZC)BerlinGermany
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering ResearchUniversity of BernBernSwitzerland
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Cesarovic N, Weisskopf M, Stolte T, Trimmel N, Hierweger MM, Hoh T, Iske J, Waschkies C, Chen JL, van Gelder E, Leuthardt A, Glaus L, Rösch Y, Stoeck CT, Wolint P, Obrist D, Kozerke S, Falk V, Emmert MY. Development of a Translational Autologous Microthrombi-Induced MINOCA Pig Model. Circ Res 2023. [PMID: 37395118 DOI: 10.1161/circresaha.123.322850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Nikola Cesarovic
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland (N.C., T.S., E.v.G., P.W., V.F.)
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany (N.C., J.I., V.F., M.Y.E.)
| | - Miriam Weisskopf
- Center for Preclinical Development, University Hospital of Zurich, University of Zurich, Switzerland (M.W., N.E.T., M.M.H., A.L., C.T.S.)
| | - Thorald Stolte
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland (N.C., T.S., E.v.G., P.W., V.F.)
| | - Nina Trimmel
- Center for Preclinical Development, University Hospital of Zurich, University of Zurich, Switzerland (M.W., N.E.T., M.M.H., A.L., C.T.S.)
| | - Melanie M Hierweger
- Center for Preclinical Development, University Hospital of Zurich, University of Zurich, Switzerland (M.W., N.E.T., M.M.H., A.L., C.T.S.)
| | - Tobias Hoh
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (T.H., C.W., C.T.S., S.K.)
| | - Jasper Iske
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany (N.C., J.I., V.F., M.Y.E.)
| | - Conny Waschkies
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (T.H., C.W., C.T.S., S.K.)
| | - Jia Lu Chen
- Department of Mechanical and Process Engineering, University and ETH Zurich, Switzerland (J.L.C.)
| | - Eva van Gelder
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland (N.C., T.S., E.v.G., P.W., V.F.)
| | - Andrea Leuthardt
- Center for Preclinical Development, University Hospital of Zurich, University of Zurich, Switzerland (M.W., N.E.T., M.M.H., A.L., C.T.S.)
| | | | - Yannick Rösch
- ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland (Y.R., D.O.)
| | - Christian T Stoeck
- Center for Preclinical Development, University Hospital of Zurich, University of Zurich, Switzerland (M.W., N.E.T., M.M.H., A.L., C.T.S.)
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (T.H., C.W., C.T.S., S.K.)
| | - Petra Wolint
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland (N.C., T.S., E.v.G., P.W., V.F.)
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland (Y.R., D.O.)
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (T.H., C.W., C.T.S., S.K.)
| | - Volkmar Falk
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland (N.C., T.S., E.v.G., P.W., V.F.)
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany (N.C., J.I., V.F., M.Y.E.)
- Charité-Universitätsmedizin Berlin, Germany (V.F., M.Y.E.)
- Deutsches Zentrum für Herz-Kreislaufforschung, Partner Site Berlin, Germany (V.F., M.Y.E.)
| | - Maximilian Y Emmert
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany (N.C., J.I., V.F., M.Y.E.)
- Charité-Universitätsmedizin Berlin, Germany (V.F., M.Y.E.)
- Deutsches Zentrum für Herz-Kreislaufforschung, Partner Site Berlin, Germany (V.F., M.Y.E.)
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland (M.Y.E.)
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Rösch Y, Eggenberger D, Kuster Y, Widmer L, Frey S, Schwartz R, Nef C, Ulmer J, Obrist D. Enhanced Drug Delivery for Cardiac Microvascular Obstruction with an Occlusion-Infusion-Catheter. Ann Biomed Eng 2023; 51:1343-1355. [PMID: 36681747 PMCID: PMC10172228 DOI: 10.1007/s10439-023-03142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
Microvascular Obstruction (MVO) is a common consequence of acute myocardial infarction. MVO is underdiagnosed and treatment is often nonspecific and ineffective. A multi-scale in-vitro benchtop model was established to investigate drug perfusion in MVO affected microcirculation. The central element of the benchtop model was a fluidic microchip containing channels with diameters between [Formula: see text] and 50 μm representing [Formula: see text] of the microvascular tree fed by the left anterior descending artery (LAD). The outlets of the chip could be closed to mimic MVO. Two methods for intracoronary infusion of pharmacologic agents (simulated by dye) to regions with MVO were investigated using an occlusion-infusion catheter. The first case was a simple, bolus-like infusion into the LAD, whereas the second case consisted of infusion with concomitant proximal occlusion of the LAD phantom with a balloon. Results show that local dye concentration maxima in the chip with MVO were 2.2-3.2 times higher for the case with proximal balloon occlusion than for the conventional infusion method. The cumulated dose could be raised by a factor 4.6-5.2. These results suggest that drug infusion by catheter is more effective if the blood supply to the treated vascular bed is temporarily blocked by a balloon catheter.
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Affiliation(s)
- Yannick Rösch
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland.
| | - David Eggenberger
- Institute for Microtechnology and Photonics, OST University of Applied Sciences, Buchs SG, Switzerland
| | - Yves Kuster
- Institute for Microtechnology and Photonics, OST University of Applied Sciences, Buchs SG, Switzerland
| | - Lino Widmer
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
| | | | | | - Cornelia Nef
- Institute for Microtechnology and Photonics, OST University of Applied Sciences, Buchs SG, Switzerland
- matriq AG, St. Gallen, Switzerland
| | - Jens Ulmer
- Institute for Microtechnology and Photonics, OST University of Applied Sciences, Buchs SG, Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
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Thirugnanasambandam M, Frey S, Rösch Y, Mantegazza A, Clavica F, Schwartz RS, Cesarovic N, Obrist D. Effect of Collateral Flow on Catheter-Based Assessment of Cardiac Microvascular Obstruction. Ann Biomed Eng 2022; 50:1090-1102. [PMID: 35639221 PMCID: PMC9363345 DOI: 10.1007/s10439-022-02985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Abstract
Cardiac microvascular obstruction (MVO) associated with acute myocardial infarction (heart attack) is characterized by partial or complete elimination of perfusion in the myocardial microcirculation. A new catheter-based method (CoFI, Controlled Flow Infusion) has recently been developed to diagnose MVO in the catheterization laboratory during acute therapy of the heart attack. A porcine MVO model demonstrates that CoFI can accurately identify the increased hydraulic resistance of the affected microvascular bed. A benchtop microcirculation model was developed and tuned to reproduce in vivo MVO characteristics. The tuned benchtop model was then used to systematically study the effect of different levels of collateral flow. These experiments showed that measurements obtained in the catheter-based method were adversely affected such that collateral flow may be misinterpreted as MVO. Based on further analysis of the measured data, concepts to mitigate the adverse effects were formulated which allow discrimination between collateral flow and MVO.
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Affiliation(s)
| | - Sabrina Frey
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
- CorFlow Therapeutics AG, Baar, Switzerland
| | - Yannick Rösch
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
| | - Alberto Mantegazza
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
| | | | - Nikola Cesarovic
- Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
- Cardiosurgical Research Group, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland.
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