Novel technologies in the treatment of intracranial aneurysms

Zuckerman, Scott L.; Eli, Ilyas; Morone, Peter J.; Dewan, Michael C.; Mocco, J

doi:10.1179/1743132814y.0000000318

Cited by 15 publications

(12 citation statements)

References 96 publications

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“…Endovascular treatment of intracranial aneurysms with flow diverters has proven to be a disruptive technology, with favorable clinical outcomes over traditional coiling and stent assisted coiling. 1,2 Flow diverters typically consist of tubular porous meshes that are deployed across the aneurysm neck that divert blood flow back into the parent vessel and away from the aneurysm. Thus, gradual coagulation of blood in the aneurysm followed by scaffolding at the neck leads to long-term healing of the aneurysm.…”

Section: Introductionmentioning

confidence: 99%

Thrombogenicity assessment of Pipeline Flex, Pipeline Shield, and FRED flow diverters in an in vitro human blood physiological flow loop model

Girdhar

Andersen

Pangerl

et al. 2018

J Biomedical Materials Res

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Endovascular treatment of intracranial aneurysms with endoluminal flow diverters (single or multiple) has proven to be clinically safe and effective, but is associated with a risk of thromboembolic complications. Recently, a novel biomimetic surface modification with covalently bound phosphorylcholine (Shield Technology™) has shown to reduce the material thrombogenicity of the Pipeline flow diverter. Thrombogenicity of Pipeline Flex, Pipeline Shield, and Flow Redirection Endoluminal Device (FRED) in the presence of human blood under physiological flow conditions—in addition to relative increase in thrombogenicity with multiple devices—remains unknown and was investigated here. Thrombin generation (mean ± SD; μg/mL; thrombin–antithrombin complex or TAT) was measured as FRED (30.3 ± 2.9), Pipeline (13.9 ± 4.4), Pipeline Shield (0.4 ± 0.3), and negative control (no device; 0.1 ± 0.0). Platelet activation (mean ± SD; IU/μL; beta‐thromboglobulin or βTG) was measured as FRED (148 ± 45), Pipeline (92.8 ± 41), Pipeline Shield (16.2 ± 3.5), and negative control (2.70 ± 0.16). FRED was significantly more thrombogenic than Pipeline and Pipeline Shield (p < 0.05) for TAT. Additionally, Pipeline Shield had significantly lower TAT and βTG than the other devices tested (p < 0.05) and these were comparable to the negative control (p > 0.05). TAT and βTG scaled proportionately with multiple Pipeline devices (N = 6) but was unaffected by multiple Pipeline Shield (N = 6) devices—the latter being statistically similar to negative control (p > 0.05). © 2018 The Authors. Journal Of Biomedical Materials Research Part A Published By Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 3195–3202, 2018.

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Section: Introductionmentioning

confidence: 99%

Thrombogenicity assessment of Pipeline Flex, Pipeline Shield, and FRED flow diverters in an in vitro human blood physiological flow loop model

Girdhar

Andersen

Pangerl

et al. 2018

J Biomedical Materials Res

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“… 1 Flow diversion devices are a recent and significant shift in the treatment of these vascular anomalies. 2 3 Unlike intrasaccular devices, flow diverters consist of a highly porous metal stent deployed in the parent artery covering the aneurysm neck in order to divert blood flow away from the aneurysm—thereby driving the gradual thrombosis and healing of the aneurysm sac over time. Owing to the approximately 30% metal coverage of the vessel wall, these devices also provide a scaffold for endothelialization across the aneurysm neck.…”

Section: Introductionmentioning

confidence: 99%

Thrombogenicity of flow diverters in an ex vivo shunt model: effect of phosphorylcholine surface modification

Hagen

Girdhar

Wainwright

et al. 2016

J NeuroIntervent Surg

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BackgroundFlow diverters offer a promising treatment for cerebral aneurysms. However, they have associated thromboembolic risks, mandating chronic dual antiplatelet therapy (DAPT). Shield Technology is a phosphorylcholine surface modification of the Pipeline Embolization Device (PED) flow diverter, which has shown significant reductions in material thrombogenicity in vitro.ObjectiveTo compare the thrombogenicity of PED, PED with Shield Technology (PED+Shield), and the Flow-Redirection Endoluminal Device (FRED)—with and without single antiplatelet therapy and DAPT—under physiological flow.MethodsAn established non-human primate ex vivo arteriovenous shunt model of stent thrombosis was used. PED, PED+Shield, and FRED were tested without antiplatelet therapy, with acetylsalicylic acid (ASA) monotherapy, and with DAPT. Radiolabeled platelet deposition was quantified over 1 hour for each device and total fibrin deposition was also quantified.ResultsCumulative statistical analysis showed significantly lower platelet deposition on PED compared with FRED. The same statistical model showed significant decreases in platelet deposition when ASA, clopidogrel, or Shield Technology was used. Direct comparisons of device performances within antiplatelet conditions showed consistent significant decreases in platelet accumulation on PED+Shield relative to FRED. PED+Shield showed significant reductions in platelet deposition compared with unmodified PED without antiplatelet therapy and with DAPT. PED accumulated minimal fibrin with and without Shield Technology.ConclusionsIn this preclinical model, we have shown that the Shield Technology phosphorylcholine modification reduces the platelet-specific thrombogenicity of a flow diverter under physiologically relevant flow with and without DAPT. We have further identified increased fibrin-driven thrombogenicity associated with FRED relative to PED.

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“…Expansion of the central part recapitulates the concept of assisted coiling using compliant balloons. The significant expansion of the central part maximizes neck coverage in branching locations and facilitates embolization of bifurcation aneurysms (Figure 8 ) [ 25 ].…”

Section: Reviewmentioning

confidence: 99%

“…The delayed rupture of aneurysms can be explained by the incomplete coverage of the neck with persistent flow into the sac. Vessel perforations have been reported to occur with distal access wire and cases of balloon inflation used for remodeling the implanted device [ 25 ].…”

Section: Reviewmentioning

confidence: 99%

Stents and Stent Mimickers in Endovascular Management of Wide-neck Intracranial Aneurysms

Khattak¹,

Sibaie²,

Anwar³

et al. 2018

Cureus

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Subarachnoid hemorrhage due to a ruptured cerebral aneurysm is a disastrous event accounting for approximately 5%-15% of all stroke cases and has a high mortality rate. One of the major goals in the management of these patients is to prevent rebleeding by securing the aneurysm either surgically or by endovascular means. Endovascular treatment is considered the first line of treatment for intracranial aneurysms; however, wide-neck aneurysms (WNAs) are specifically difficult to treat by endovascular means due to the difficulty in achieving a stable coil mass inside the aneurysm sac. To overcome this problem, assisted endovascular treatment techniques and devices have evolved over the years. Amongst these, stent-assisted coiling (SAC) techniques provide a scaffold for coil embolization. The concept of the stent-assisted technique inspired creative pioneers to invent new tools like the PulseRider (Pulsar Vascular, Inc. CA, USA) and the pCONUS (Phenox GmbH, Germany), which are a great help in managing wide-neck and bifurcation aneurysms. The concept of stent within stents and its related hemodynamic effect has led to the novel development of flow diverters for reconstructing the arterial wall and correcting the hemodynamic disturbances. In this article, we review the stents and stent-like devices currently in practice for the endovascular management of wide-neck and branch intracranial aneurysms.

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Novel technologies in the treatment of intracranial aneurysms

Cited by 15 publications

References 96 publications

Thrombogenicity assessment of Pipeline Flex, Pipeline Shield, and FRED flow diverters in an in vitro human blood physiological flow loop model

Thrombogenicity assessment of Pipeline Flex, Pipeline Shield, and FRED flow diverters in an in vitro human blood physiological flow loop model

Thrombogenicity of flow diverters in an ex vivo shunt model: effect of phosphorylcholine surface modification

Stents and Stent Mimickers in Endovascular Management of Wide-neck Intracranial Aneurysms

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