Development of a novel perfused human cadaveric model for endovascular device testing and training

Background: Interventional radiology (IR) offers many benefits for patients and healthcare systems, such as faster recovery, less pain, fewer complications, and lower costs than traditional surgery. The main drivers for the continued growth in IR are the increasing prevalence of chronic diseases, the technological advancements in imaging technology, and the improving healthcare infrastructure and expenditure in emerging regions. However, this growth also encounters obstacles that prevent the realisation of the technology’s benefits. A major obstacle is the shortage of trained professionals who can perform these highly skilled interventions. This is partly because of the lack of realistic and suitable models for training and device testing. The current models, such as animal models, benchtop models, and high-fidelity models, have considerable drawbacks. Therefore, there is a need for more realistic models that enable skill acquisition and provide evidence of efficacy during device testing. Method: This study used empirical methods to develop perfused human cadaveric models for endovascular interventions. A set of evaluation criteria was updated to incorporate modern endovascular interventional needs, this provided the template for a binary yes/no objective assessment of model performance. Thiel embalmed human cadavers are available in Dundee, and have qualities such as patent vascular system, stability at room temperature and a bequeath of three years that makes them ideal for this purpose. Extracorporeal perfusion techniques were developed for the perfusion of the arterial and venous system of the cadavers. Stable access and perfusion methods were established, facilitating endovascular procedures such as aortic stenting, lower-limb interventions, and coronary procedures to be conducted. A retrospective analysis of vessel access was conducted, involving a variety of anatomical regions, including arterial and venous systems within the Thiel cadaver. The culmination of this study was to apply empirical methods to develop a perfused Thiel cadaveric model tailored for endovascular stroke thrombectomy (EST). The potential of the developed model was demonstrated through its evaluation by experienced interventionalists conducting key training requirements for EST procedures. Results: The perfused human cadaveric stroke thrombectomy model was feasible and effective for performing the key training requirements required of interventionalists conducting stroke thrombectomy procedures: Selective cerebral angiography, Carotid stenting and cerebrovascular thrombectomy. Conclusion: The perfused human cadaveric model is a viable option for endovascular device testing and training and has been included in guidelines as a model for training the next generation of stroke interventionalists. The developed model has several limitations, the entire procedure cannot be conducted from vessel access to vessel closure, but rather the extra- and intracranial components of the procedure were conducted. Further studies to characterise the physiological conditions in the model and validate the teaching model would further advance this work