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BackgroundSurface-modified flow diverters (FDs) designed to reduce thrombogenicity represent the next frontier for intracranial aneurysm treatment. The Derivo Embolization Device (DED) is a novel FD with titanium oxide and titanium oxynitride finishing of the struts. We performed a systematic review of pertinent literature, aiming to evaluate the device’s effectiveness and safety.MethodsA literature search of PubMed, Embase, and MEDLINE was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsFive studies comprising 481 aneurysms were included. These studies were conducted in Turkey, Brazil, Germany, Poland, and Italy; two were prospective and three were retrospective. Twenty-six aneurysms (5.4%) were ruptured. The antiplatelet regimens were heterogeneous, but dual antiplatelet therapy was administered preprocedurally in all studies and maintained for 3–12 months before a switch to single antiplatelet therapy. The rate of periprocedural ischemic and hemorrhagic complications was 4.9% (95% CI 2.9% to 7%). Adjunctive coiling was used in 25.6% (95% CI 11.4% to 39.8%) of aneurysms. The complete angiographic occlusion rate was 81.4% (95% CI 71.3% to 91.5%), mortality rate was 2.1% (95% CI 0.4% to 3.9%), with follow-up ranging from 9 to 18 months. Delayed aneurysm rupture was reported in one patient.ConclusionsThe DED has been increasingly used in other countries. We identified low rates of periprocedural complications and mortality and a high rate of complete occlusion.

BackgroundAcute isolated posterior cerebral artery occlusions (aPCAOs) were excluded or under-represented in major randomized trials of mechanical thrombectomy (MT). The benefit of MT in comparison to intravenous tissue plasminogen activator (alteplase; IV-tPA) alone in these patients remains controversial and uncertain.MethodsWe performed a systematic search of PubMed, MEDLINE, and EMBASE databases for articles comparing MT with or without bridging IV-tPA and IV-tPA alone for aPCAO using keywords (‘posterior cerebral artery’, ‘thrombolysis’ and ‘thrombectomy’) with Boolean operators. Extracted data from patients reported in the studies were pooled into groups (MT vs IV-tPA alone) for comparison. Estimated rates for favorable outcome (modified Rankin scale score 0–2), symptomatic intracranial hemorrhage (sICH), and mortality were extracted.ResultsSeven articles (201 MT patients, 64 IV-tPA) were included, all retrospective. There was no statistically significant difference between pooled groups in median age, median presentation National Institutes of Health Stroke Scale (NIHSS) score, PCAO segment, and median time from symptom onset to puncture or needle. The recanalization rate was significantly higher in the MT group than the IV-tPA group (85.6% vs 53.1%, p<0.00001). Odds ratios for favorable outcome (OR 1.5, 95% CI 0.8 to 2.5), sICH (OR 1.1, 95% CI 0.2 to 5.5), and mortality (OR 1.4, 95% CI 0.5 to 3.6) did not significantly favor any modality.ConclusionsWe found no significant differences in odds of favorable outcome, sICH, and mortality in MT and IV-tPA in comparable aPCAO patients, despite superior MT recanalization rates. Equipoise remains regarding the optimal treatment modality for these patients.

Stimulus-responsive nanomaterials have mainly been employed to ablate or destroy tissues or to facilitate controlled release of drugs or biologics. Herein, we demonstrate the potential of stimulus-responsive nanomaterials to promote tissue regeneration via a non-pharmacological and noninvasive strategy. Thin nanofilms of an optically-absorbing organic dye or nanoparticle (single-walled graphene nanoribbons[SWOGNR]) were placed over (without touching the skin) a rodent femoral fracture site. A nanosecond pulsed near-infrared laser diode was employed to generate photoacoustic (PA) signals from the nanofilms. X-ray micro-computed tomography (microCT), histology, and mechanical testing results showed that daily PA stimulations of upto 45 min for 6 weeks (complete fracture healing) do not adversely affect bone regeneration and quality. Further, microCT and histological analysis showed 10 min daily stimulation for 2 weeks significantly increases bone quantity at the fracture sites of rats exposed to the nanoparticle-generated PA signals. In these rats, up to threefold increase in bone volume to callus volume ratio and twofold increase in bone mineral density within the callus were noted, compared to rats that were not exposed to the photoacoustic signals. The results taken together indicate that nanofilm-generated photoacoustic signals serve as an anabolic stimulus for bone regeneration. The results, in conjugation with the ability of these nanofilms to serve as PA contrast agents, present opportunities toward the development of integrated noninvasive imaging and noninvasive or invasive treatment strategies for bone loss due to disease or trauma.

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