• de OliveiraMarcelo Magaldi RibeiroMMRPlacentarium, Federal University of Minas Gerais and Felicio Rocho Hospital, Belo Horizonte, Brazil. Electronic address: mmagaldi@hotmail.com., Arthur Nicolato, Jose Augusto Malheiros, Vieira CostaPollyana HelenaPHPlacentarium, Federal University of Minas Gerais and Felicio Rocho Hospital, Belo Horizonte, Brazil., Ana Clara Fidelis, Maria Angélica Tibães Oliveira, Taise Mosso Ramos, Geraldo Muzzi Lima Junior, and Leonardo Avellar.
• Placentarium, Federal University of Minas Gerais and Felicio Rocho Hospital, Belo Horizonte, Brazil. Electronic address: mmagaldi@hotmail.com.
• World Neurosurg. 2021 Apr 1; 148: e115-e120.

BackgroundStroke microsurgical cerebrovascular thrombectomy reports are limited, although this technique could be used in many centers as a primary treatment or a salvage intervention option. It requires great ability, so our aim is to describe and validate a stroke microsurgical thrombectomy ex vivo simulator with operative nuances analysis.MethodsHuman placenta (HP) models simulated middle cerebral artery vessels with intraluminal thrombus to be microsurgically excised. Six neurosurgeons performed 1-mm and 2-mm longitudinal and transverse arteriotomy in different arteries to remove a 1.5-cm length thrombus. Validation through construct validity compared time to complete the task, complete vessel cleaning, vessel manipulation, vessel stenosis, and leakage in both techniques.ResultsAll 6 HP models reproduced with fidelity stroke microsurgical thrombectomy, so participants completed 24 sessions, 4 for each neurosurgeon on the same model in different arteries. Construct validity highlighted microsurgical technical difficulties with positive results obtained by parameters variation during performance. Transverse arteriotomy with 1-mm length had best results (P < 0.05) allowing complete thrombus removal, less stenosis, and minor leakage in abbreviated time.ConclusionsA HP simulator can reproduce with high fidelity all stroke microsurgical thrombectomy part tasks. Transverse 1-mm arteriotomy followed by thrombectomy and 2 simple sutures can fulfill all quality assurance aspects in such intervention accordingly to training model, due to easier vessel opening, complete thrombus removal, no stenosis, and faster microsuture.Copyright © 2021 Elsevier Inc. All rights reserved.

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