Endovascular Perforation Method

The endovascular perforation method is a technique used primarily in experimental and clinical settings for controlled arterial perforation. It is commonly employed in preclinical research, vascular interventions, and certain neurosurgical procedures.

### 1. Definition and Applications The endovascular perforation method refers to the intentional creation of a vessel wall perforation via an endovascular approach. It is mainly used in: - Experimental models of subarachnoid hemorrhage (SAH): Used in animal studies to induce SAH by perforating the intracranial arteries. - Endovascular interventions: Controlled perforation techniques may be utilized in challenging cases where access to occluded vessels is needed. - Neurovascular procedures: In cases of iatrogenic perforation during coiling or stent placement, management strategies for vessel perforation are essential.

### 2. Techniques and Tools The method generally involves the use of: - Microcatheters and microwires (0.010–0.014 inches) to advance into small-caliber vessels. - Balloon-assisted or stent-assisted techniques to control flow during or after perforation. - Radiofrequency (RF) or laser-assisted perforation for precise control in experimental setups. - Guidewires for controlled penetration of arterial walls.

### 3. Clinical Significance - Subarachnoid Hemorrhage Models: In animal models, the perforation method is used to mimic aneurysmal rupture, providing insights into the pathophysiology and treatment of SAH. - Iatrogenic Perforations: In interventional neurovascular procedures, vessel perforation can lead to hemorrhagic complications, necessitating rapid hemostasis using coils, stent-assisted occlusion, or glue embolization.

### 4. Management of Perforation If an unintended perforation occurs during an endovascular procedure, management includes: 1. Immediate cessation of anticoagulation/antiplatelet agents. 2. Balloon inflation to temporarily stop bleeding. 3. Coil embolization if the vessel is non-essential. 4. Stent deployment to seal the perforation. 5. Reversal agents for anticoagulation if needed.

### 5. Risks and Complications - Hemorrhagic transformation - Distal ischemia due to vessel sacrifice - Reperfusion injury in experimental models

The endovascular perforation method is a critical tool in vascular research and neurointerventional procedures, requiring careful technique and management strategies to mitigate risks.