Correlation of Flow Diverter Malapposition at the Aneurysm Neck with Incomplete Aneurysm Occlusion in Patients with Small Intracranial Aneurysms: A Single-Center Experience

Long, Shuhai; Shi, Shuailong; Tian, Qi; Wei, Zhuangzhuang; Ma, Ji; Wang, Ye; Yang, Jie; Han, Xinwei; Li, Tengfei

doi:10.3174/ajnr.a8079

AJNR Am J Neuroradiol

2023

DOI: 10.3174/ajnr.a8079

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Correlation of Flow Diverter Malapposition at the Aneurysm Neck with Incomplete Aneurysm Occlusion in Patients with Small Intracranial Aneurysms: A Single-Center Experience

Shuhai Long,

Shuailong Shi,

Qi Tian

et al.

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2024

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Cited by 4 publications

References 31 publications

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Pipeline Embolization device for the treatment of unruptured intracranial saccular aneurysms: a systematic review and meta-analysis of long-term outcomes

Rios-Zermeno,

Ghaith,

Perez-Vega

et al. 2024

Neurosurg Rev

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Pipeline Embolization device for the treatment of unruptured intracranial saccular aneurysms: a systematic review and meta-analysis of long-term outcomes

Rios-Zermeno,

Ghaith,

Perez-Vega

et al. 2024

Neurosurg Rev

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Preclinical in vitro and in vivo results of the new silk vista flow diverter with P8RI coating

Cortese,

Forestier,

Bardet

et al. 2024

J NeuroIntervent Surg

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BackgroundFlow diverting stents (FDS) have transformed the treatment of intracranial aneurysms; however, their metallic structure associated with their intra-luminal positioning hamper angiographic and clinical outcomes. Therefore, there is a need to develop FDS with optimized surfaces that reduce thrombogenicity while promoting the healing process and endothelialization.MethodsP8RI, a peptide mimicking the CD31 protein, was previously developed and grafted onto Silk Vista (SV) FDS. P8RI-SV and bare-SV were used in vitro in a blood loop model to test their hemocompatibility using human whole blood and in vivo using the rabbit elastase model for optical coherence tomography (OCT) comparisons of neointimal formation at day 5 and day 28.ResultsAfter blood loop incubation, P8RI-SV showed significant reduction in fibrin binding (p=0.004) and platelet adhesion (p=0.041) compared with bare-SV. Similarly, derivative markers measured in blood, thromboxane B2 (platelet activation) and Thrombin-Antithrombin III complexes (coagulation activation), were also significantly reduced in the P8RI-SV group (both p=0.002). In vivo, complete or near-complete occlusion was reached in all aneurysms (n=6) at day 28. Excellent rate of stent-coverage ratio was obtained at day 5 (89.3% (79.1%–98.7%)) comparable to the observation at day 28 (91.8% (79.1%–100%); p=0.44). These rates were significantly higher compared with bare-SV at day 5 (77.8% (58.3%–86.8%); p<0.001) and at day 28 (67.7% (52.6%–88.9%); p<0.0001).ConclusionIn vitro results confirm enhanced hemocompatibility with a significant anti-thrombotic effect of the P8RI-SV. In vivo results provide evidence of rapid neo-intimal growth reaching near-complete tissue healing as early as day 5 in a rabbit model.

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Neck apposition is a key factor for aneurysm occlusion after Woven EndoBridge device embolization

Cortese,

Juhasz,

Rodriguez-Erazú

et al. 2024

J NeuroIntervent Surg

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BackgroundSealing of the aneurysm neck with a Woven EndoBridge (WEB) device is recommended for disrupting the blood flow inside the aneurysm. This study investigates the relationship between WEB neck apposition and aneurysm occlusion rates.MethodsAneurysms treated with a WEB from March 2017 to May 2022 at a single center were included. WEB neck apposition (poor/good) and WEB protrusion (yes/no) were evaluated on post-detachment high resolution cone beam CT images. Angiographic occlusion was assessed with the Bicêtre Occlusion Scale score (BOSS). Univariate and multivariable analysis tested the association between neck apposition and occlusion rates.ResultsThe study included 159 aneurysms in 141 patients (mean age 55.8±11.2 years; 64.2% women). Good neck apposition and protrusion were noted in 123 (77.4%) and 30 (18.9%) cases, respectively. Inter-rater agreements were good for neck apposition (κ=0.75) and protrusion (κ=0.78). Complete and adequate occlusion was achieved in 104 (65%) and 130 (82%) cases, respectively (median follow-up 18 months). Good neck apposition was a strong independent predictor for both adequate (adjusted OR (aOR)=5.9, 95% CI 2.4 to 14.9; P<0.001) and complete occlusion (aOR=7.1, 95% CI 3.0 to 18.1; P<0.001). Protrusion was more frequent in the adequate occlusion group versus the aneurysm recurrence group without reaching statistical significance (P=0.06), but was associated with more thromboembolic complications (9/30 (30%) vs 12/129 (9%); P<0.01). WEB shape modification was significantly greater in poor apposition cases (P=0.03).ConclusionsAchieving good neck apposition of the WEB strongly predicts aneurysm occlusion during follow-up. WEB protrusion should be minimized due to the increase in thromboembolic risk with limited impact on aneurysm occlusion.

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Correlation of Flow Diverter Malapposition at the Aneurysm Neck with Incomplete Aneurysm Occlusion in Patients with Small Intracranial Aneurysms: A Single-Center Experience

Cited by 4 publications

References 31 publications

Pipeline Embolization device for the treatment of unruptured intracranial saccular aneurysms: a systematic review and meta-analysis of long-term outcomes

Pipeline Embolization device for the treatment of unruptured intracranial saccular aneurysms: a systematic review and meta-analysis of long-term outcomes

Preclinical in vitro and in vivo results of the new silk vista flow diverter with P8RI coating

Neck apposition is a key factor for aneurysm occlusion after Woven EndoBridge device embolization

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