Flow-Diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Liu, Junyu; Cao, Fang; Zhenmei, Nibu; Guo, Yuxin; Li, Yifeng; Yuan, Dun; Jiang, Weixi; Yan, Junxia

doi:10.1097/js9.0000000000000762

Cited by 4 publications

(1 citation statement)

References 74 publications

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“…The patency of side branches covered by FDDs is therefore controversial. A 2023 meta-analysis by Liu et al, which included 57 studies and 3789 patients with intracranial aneurysm treated with FDD, showed that the risk of branch occlusion-related complications was low (incidence rate < 5%) for the branches evaluated [ 16 ]. Similarly, studies in rabbits have reported no adverse events due to branch occlusion [ 12 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the EMBOPIPE flow diverter device: in vivo and in vitro experiments

Zhu,

Zeng,

Liu

et al. 2024

Chin Neurosurg Jl

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Background Although flow diverter device (FDD) has brought revolutionized advances in endovascular treatment of intracranial aneurysms, it also presents considerable drawbacks as well, as the innovation for novel device has never stopped. This preclinical research aims to evaluate the safety and efficacy of a newly developed FDD, the EMBOPIPE, through in vivo and in vitro experiments. Methods Aneurysms were induced in 20 New Zealand white rabbits which were randomized to three follow-up groups according to the time elapsed after EMBOPIPE implantation (28, 90, and 180 days). Additional EMBOPIPEs were implanted in the abdominal aorta to cover the renal artery in nine rabbits. Angiography was performed immediately after device placement in all groups. Aneurysm occlusion, patency of renal arteries, and pathological outcomes were assessed. For the in vitro experiments, we measured the thrombogenic potential of EMBOPIPEs (n = 5) compared with bare stents (n = 5) using the Chandler loop model. Evaluation indicators were the platelet counts, macroscopic observations and scanning electron microscopy. Results EMBOPIPEs were successfully deployed in 19 of 20 rabbit aneurysms (95.0%). The rates of complete or near-complete aneurysm occlusion were 73.3%, 83.3%, and 100% in the 28-, 90-, and 180-day groups, respectively. All renal arteries covered by EMBOPIPEs remained patent, and the mean difference in renal artery diameter before and after the device placement in the three groups was 0.07 mm, 0.10 mm, and 0.10 mm, respectively (p = 0.77). Renal pathology was normal in all cases. The pathological findings of the aneurysms were as follows: thickened and adequate neointimal coverage at the aneurysm neck, minimal inflammatory response, near-complete smooth muscle cell layer, and endothelialization along the device. In vitro experiments showed that the platelet counts were significantly higher in EMBOPIPE blood samples than in bare stent samples and that platelet adhesion to the device was lower in the EMBOPIPE stent struts compared with bare stent struts through macroscopic observations and scanning electron microscopy. Conclusions The EMBOPIPE can achieve high rates of aneurysm occlusion while maintaining excellent branch artery patency. It exhibited wonderful pathological results. This novel device with phosphorylcholine surface modification could reduce platelet thrombus attached to the stent struts.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the EMBOPIPE flow diverter device: in vivo and in vitro experiments

Zhu,

Zeng,

Liu

et al. 2024

Chin Neurosurg Jl

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Treatment of unruptured intracranial vertebral artery dissection aneurysms with Flow Diverter compared with conventional stent-assisted coiling—a single-center study

Zhang,

Zhong,

Zhou

et al. 2024

Acta Neurochir

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Aim Flow diverters (FDs) are being increasingly used off-label for treatment of intracranial vertebral artery dissection aneurysms (IVADAs). However, the safety and efficacy of FDs for unruptured IVADAs remain unclear. This study was performed to investigate whether FDs-alone are safer and more effective than conventional stent-asisted coiling. Methods We retrospectively analyzed 152 patients who underwent endovascular stenting from December 2011 to December 2022. The baseline data, aneurysm characteristics, surgical details, perioperative complications, follow-up angiography, and clinical outcomes were collected and compared between patients who underwent stenting with FD-alone versus conventional stent-asisted coiling. Propensity score matching was also conducted. Results All 152 patients underwent successful endovascular therapy. Forty patients were treated with FDs-alone, and 112 were treated with conventional stent-asisted coiling (including 62 with double stents). The complete occlusion rate was 93.75% in the FD group and 93.61% in the conventional stent group ( p = 0.979). The complication rate was 5.00% in the FD group and 8.93% in the conventional stent group ( p = 0.653). The in-stent restenosis rate was 3.13% in the FD group and 5.32% in the conventional stent group ( p = 0.615). The procedure duration was significantly shorter in the FD than conventional stent group ( p = 0.034). After propensity score matching, 37 patients with FDs were successfully matched, and the procedure duration was still significantly shorter in the FD group ( p = 0.042). Conclusion FD placement is a safe and effective treatment for IVADAs. It is also a simpler procedure with a shorter operation time than conventional stent placement. Trial registration number: ChiCTR2300074171 ClinicalTrials.gov ID:NCT06134557

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The aneurysm occlusion and recurrence of posterior communicating artery aneurysms following the treatment with the pipeline embolization device

Xue,

Liang,

Miao

et al. 2024

Neurosurg Rev

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Flow-Diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Cited by 4 publications

References 74 publications

Evaluation of the EMBOPIPE flow diverter device: in vivo and in vitro experiments

Evaluation of the EMBOPIPE flow diverter device: in vivo and in vitro experiments

Treatment of unruptured intracranial vertebral artery dissection aneurysms with Flow Diverter compared with conventional stent-assisted coiling—a single-center study

The aneurysm occlusion and recurrence of posterior communicating artery aneurysms following the treatment with the pipeline embolization device

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