A new dynamic model for in vitro evaluation of intravascular devices.

INTRODUCTION:: A dynamic model to evaluate thrombus formation on intravascular catheters in vitro is presented. The model enables fluid infusion, variation in the catheter orientation, and variable flow conditions. It was applied on a catheter used to shunt cerebrospinal fluid to a vein, a dural venous sinus, for the treatment of hydrocephalus. METHODS:: Fresh human blood-filled circuits were circulated in a non-occlusive roller pump. A catheter infused either with cerebrospinal fluid, Ringer's lactate, or no fluid (control) was inserted through each circuit's wall. Sixteen circuits (six cerebrospinal fluid, six Ringer's lactate, four control) ran for 60 min. Qualitative assessment was performed by measuring viscoelastic properties of blood at the start and end of the experiment; quantitative evaluation of clot formation by scanning electron microscope. RESULTS:: Average blood velocity was 79 mm/s, with a pressure wave between 5 and 15 mm Hg. At the experiment's end, the infused fluid represented 5.88% of the blood/infusion volume in the circuit. The control circuits showed no statistical difference between the start and end for viscoelastic testing, whereas both Ringer's lactate and cerebrospinal fluid enhanced coagulation, most pronounced for the latter. Most thrombus material was observed on catheters in the cerebrospinal fluid group. Clot formation was less pronounced on the surface of the catheter facing the blood flow. DISCUSSION:: A dynamic model for intravascular catheter testing mimics better clinical conditions when evaluating blood-material interaction. Catheter position, blood flow around the catheter, and infusion fluid all have a potential impact on the hemocompatibility of a given catheter.

Treating Hydrocephalus with Retrograde Ventriculosinus Shunt: Prospective Clinical Study.

BACKGROUND: Since the 1950s, hydrocephalus has been be treated with cerebrospinal fluid (CSF) shunts, usually to the peritoneal cavity or to the right cardiac atrium. However, because of their siphoning effect, these shunts lead to nonphysiologic CSF drainage, with possible comorbidity and high revision rates. More sophisticated shunt valve systems significantly increase costs and technical complexity and remain unsuccessful in a subgroup of patients. In an attempt to obtain physiologic CSF shunting, many neurosurgical pioneers shunted towards the dural sinuses, taking advantage of the physiologic antisiphoning effect of the internal jugular veins. Despite several promising reports, the ventriculosinus shunts have not yet become standard neurosurgical practice. METHODS: In this single-center prospective clinical study, we implanted the retrograde ventriculosinus shunt, as advocated by El-Shafei, in 10 patients. This article reports on our operation technique and long-term outcome, including 4 patients in whom this shunt was implanted as a rescue operation. RESULTS: Implantation of a ventriculosinus shunt proved to be feasible, warranting physiologic drainage of CSF. However, in only 3 of 14 patients, functionality of the retrograde ventriculosinus shunt was maintained during more than 6 years of follow-up. In our opinion, these shunts fail because present venous access devices are difficult to implant correctly and become too easily obstructed. After discussion of possible causes of this frequent obstruction, a new dural venous sinus access device is presented. CONCLUSION: An easy-to-implant and thrombogenic-resistant dural venous sinus access device needs to be developed before ventriculosinus shunting can become general practice.