Haemostatic efficacy and inflammatory response of a novel beta-chitin patch in a cerebral small vessel injury model - A pilot study

Annika R Mascarenhas; Rajan S Vediappan; Alistair K Jukes; George Bouras; Lola M Kaukas; Steve Chryssidis; Jim Manavis; John Finnie; Stephen Moratti; Sarah Vreugde; Alkis J Psaltis; Peter-John Wormald

doi:10.1016/j.jocn.2023.06.001

Haemostatic efficacy and inflammatory response of a novel beta-chitin patch in a cerebral small vessel injury model - A pilot study

J Clin Neurosci. 2023 Aug:114:70-76. doi: 10.1016/j.jocn.2023.06.001. Epub 2023 Jun 13.

Affiliations

¹ Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia. Electronic address: annika.mascarenhas@sa.gov.au.
² Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia.
³ Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia.
⁴ Department of Medical Imaging, Flinders Medical Centre, Adelaide, Australia.
⁵ Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
⁶ Department of Chemistry, University of Otago, Dunedin, New Zealand.

PMID: 37321020
DOI: 10.1016/j.jocn.2023.06.001

Abstract

Objective: Rapid and efficacious haemostasis is paramount in neurosurgery. Assessing the efficacy and short- and long-term safety of haemostatic agents utilised within cerebral tissue is essential. This pilot study investigates the haemostatic efficacy and long-term safety of a novel beta-chitin patch against traditionally used agents, bipolar and Floseal, within cerebral tissue.

Methods: Eighteen Merino sheep underwent standardised distal cortical vessel injury via temporal craniotomy. Sheep were randomised to receive 2 mls Floseal, 2 cm novel beta-chitin patch, or bipolar cautery to manage bleeding. All sheep underwent cerebral magnetic resonance imaging (MRI) at three months, before euthanasia and brain harvesting for histological assessment.

Results: Beta-chitin demonstrated a trend towards a faster mean time to haemostasis (TTH) compared to Floseal (223.3 ± 199 s v. 259.8 ± 186.4 s), albeit non-significant (p = 0.234). Radiologically, cerebrocortical necrosis (p = 0.842) and oedema (p = 0.368) were noted slightly more frequently in the beta-chitin group. Histologically, severe fibrotic (p = 0.017) and granulomatous changes at the craniotomy sites were only present in the beta-chitin group (p = 0.002). Neuronal degeneration was seen in all with Floseal, but beta-chitin showed a trend towards more severe reaction when present. Bipolar use predominantly showed an inflammatory cortical reaction with substantial microvascular proliferation, and Floseal showed worse severity and depth of subpial oedema, however no statistical significance was reached.

Conclusion: All haemostats controlled bleeding, with beta-chitin demonstrating a non-inferior TTH compared to Floseal. However, it resulted in intense granulomatous and fibrotic changes, including degenerative neuronal reactions. More extensive studies are needed to assess these trends, to make further clinical inferences.

Keywords: Beta-chitin; Fibrosis; Hemostasis; Neuronal degeneration; Small vessel injury.

MeSH terms

Animals
Chitin / pharmacology
Chitin / therapeutic use
Gelatin Sponge, Absorbable
Hemostasis
Hemostasis, Surgical / methods
Hemostatics* / pharmacology
Pilot Projects
Sheep

Substances

Hemostatics
Chitin