Preliminary Experimental Evaluation of the Immediate Angiographic Occlusion Time with Use of the AMPLATZER Vascular Plug II for Carotid Artery Occlusion

Abstract

Delayed occlusion time in parent artery occlusion of brain-supplying vessels might carry risk for thromboembolic complications. Vascular plug devices are successfully used in cardiopulmonary and peripheral interventions to occlude high-flow lesions and have been adapted for use in neurointerventions. The purpose of the present study was to experimentally evaluate the immediate occlusion time of the AMPLATZER vascular plug (AVP) II-a second-generation cylindrical, self-expandable, resheathable nitinol wire mesh consisting of three lobes-in the carotid artery. AVP II devices (N = 12) 6 mm in diameter (length, 6 mm) were deployed through 6-F guiding catheters in the common carotid arteries of two pigs. After device deployment, angiography was performed to measure the time interval until no contrast agent opacification was visible distal to the AVP II, indicating complete flow cessation and occlusion of the distal vessel. Vessel diameters before deployment and after resheathing of the device were measured. Device navigation, positioning, recapturing, vasospasm, and angiographic signs of vessel injury were assessed. The mean time to total flow cessation and occlusion was 57.9 seconds (median, 44 s ± 27 [SD]; range, 26-104 s). Device navigation, positioning, and resheathing were successful in all cases. There was neither significant vasospasm nor vessel injury visible on angiography. Application and retrieval of the second-generation AVP II are uncomplicated and the device is able to achieve fast and sufficient cessation of flow in a hemodynamically comparable setting to the human carotid artery, indicating some potential to fill a gap in the neurointerventional tool box.