Use TRIPOD when validating clinical prediction models

Emergency Medicine Journal, vol. 40, pp. 81.1–81

Abstract

Background Embolization of the middle meningeal artery (MMA) is a promising minimally invasive technique that is gaining traction in the treatment of chronic subdural hematoma. Unfortunately, the human meninges and associated arteries are significantly larger than those of conventional laboratory animals, making the development of a clinically relevant animal model for testing of embolization agents elusive. Objective To introduce the posterior intercostal artery (PIA) model in swine and provide anatomical, angiographic, histological, and procedural data to validate its relevance in modeling the human MMA. Methods In human cadaveric specimens, 3D angiograms of the internal maxillary arteries (n=6) were obtained and the dura with MMA were harvested and histologically processed. Angiographic and histologic data of the human MMA were compared with the swine PIA (three animals). Then, embolization of the PIA (n=48 arteries) was conducted with liquid embolization agent (Onyx, Medtronic), and angiographic and histological results were assessed acutely (four animals) and after 30 days (two animals). Results The human MMA has equivalent diameter, length, branching pattern, 3D trajectory, and wall structure to those of swine PIAs. Each swine has 12 to 14 PIAs (6–7 per side) suitable for acute or chronic embolization, which can be performed with high fidelity using the same devices, agents, and techniques currently used to embolize the MMA. The arterial wall structure and the acute and chronic histological findings in PIAs after embolization are comparable to those of humans. Conclusions This PIA model in swine could be used for research and development; objective benchmarking of agents, devices, and techniques; and in the training of neurointerventionalists.

Authors 2

1. Bart G.J. Candel corresponding Aachen Department of Emergency Medicine

   Leiden University · Leiden University Medical Center · Máxima Medisch Centrum

   Affiliation as printed

   Department of Emergency Medicine, Leiden University Medical Centre, Leiden, The Netherlands

   Department of Emergency Medicine, Maxima Medical Centre, Veldhoven, The Netherlands bartcandel@gmail.com

   Emergency Medicine, Maxima Medical Centre, 5504 DB Veldhoven, Noord-Brabant, The Netherlands

2. Søren Kabell Nissen

   University of Southern Denmark · Hospital South West Jutland

   Affiliation as printed

   Department of Emergency Medicine, Hospital South West Jutland, Esbjerg, Syddanmark, Denmark

   Department of Regional Health Research, University of Southern Denmark, Odense, Denmark