Endovascular delivery of leads and stentrodes and their applications to deep brain stimulation and neuromodulation: a review

Abstract

<jats:p>Neuromodulation and deep brain stimulation (DBS) have been increasingly used in many neurological ailments, including essential tremor, Parkinson’s disease, epilepsy, and more. Yet for many patients and practitioners the desire to utilize these therapies is met with caution, given the need for craniotomy, lead insertion through brain parenchyma, and, at many times, bilateral invasive procedures. Currently endovascular therapy is a standard of care for emergency thrombectomy, aneurysm treatment, and other vascular malformation/occlusive disease of the cerebrum. Endovascular techniques and delivery catheters have advanced greatly in both their ability to safely reach remote brain locations and deliver devices. In this review the authors discuss minimally invasive endovascular delivery of devices and neural stimulating and recording from cortical and DBS targets via the neurovascular network.</jats:p>

Endovascular deep brain stimulation: Investigating the relationship between vascular structures and deep brain stimulation targets

“…Wired devices that deliver electric current to the target tissue via an implantable pulse generator (IPG) are commonplace in DBS today. The employment of wired stentrodes, however, would likely limit the number of implantable devices and prevent their deployment to the arterial system owing to increased risks of vessel injury and thrombosis [49]. To this end, a major advancement in endovascular deep brain stimulation will be the development of wireless information and power transfer technologies.…”

A systematic review of endovascular stent-electrode arrays, a minimally invasive approach to brain-machine interfaces

“…), reducing mechanical failure rates (wire fatigue associated with repeated neck movement), and maximizing electrode sensitivity. 4,10,16,17 Other important factors to consider are the catheter gauge and material type. Based on a single study by Oxley et al, 18 the 4-Fr catheter performed best when compared to 6-Fr and 5-Fr catheters.…”

“…An additional 10 studies were included after reviewing the sources of included articles and review articles, for a total of 22 studies. [9][10][11] Data from the included studies were independently reviewed and extracted by the first and second authors. A PRISMA flow diagram detailing methods for selection of studies is presented in Fig.…”

The future potential of the Stentrode

“…The long-term stability of the Stentrode TM , like other neurovascular stents, will depend on its incorporation into the walls of blood vessels and ability to limit the neointimal proliferation into the stent, which can lead to stenosis and occlusion of the blood vessels. However, initial results are promising and the neuroradiology clinical community has been quick to welcome this minimally invasive method [18]. Neuroradiologists routinely use permanent stents in patients' brains to keep blood vessels open.…”

“…Neuroradiologists routinely use permanent stents in patients' brains to keep blood vessels open. Endovascular therapy is the standard of care [18] in several clinical procedures including the treatment of thrombectomy, idiopathic intracranial hypertension, vascular malformation, and aneurysms. The safety record of cerebrovascular stenting has been improving and they can now reach remote locations of the brain more safely than surgical methods [4].…”