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Communicating malapposition of flow diverters assessed with optical coherence tomography correlates with delayed aneurysm occlusion.
- Source :
-
Journal of neurointerventional surgery [J Neurointerv Surg] 2018 Jul; Vol. 10 (7), pp. 693-697. Date of Electronic Publication: 2017 Nov 10. - Publication Year :
- 2018
-
Abstract
- Background: Optical coherence tomography (OCT) is a high resolution intravascular imaging method that allows visualization of flow diverter struts and the vessel wall. In this study, malapposition of the flow diverter that continues into the neck of the aneurysm, named communicating malapposition (CM), was investigated as a potential factor for delayed aneurysm healing.<br />Methods: 40 New Zealand White rabbits underwent elastase induced aneurysm creation, and were subsequently assigned to one of four treatment groups based on flow diverter type and administration of antiplatelet therapy. All animals underwent post device deployment balloon angioplasty and subsequent OCT to assess device/vessel apposition. The incidence of CM seen on OCT was assessed with a binary scoring system: 0-CM present; 1-CM absent. At 30 days, DSA was acquired to assess aneurysm healing. Aneurysm healing on terminal DSA was measured using a previously developed 5 point scale, with a score of 3 or 4 considered a positive outcome.<br />Results: All animals were grouped into a single cohort for analysis as no difference in the rate of CM or healing was seen in the four treatment groups. Significant interaction between the absence of CM and a positive outcome was confirmed by Fisher exact test (P=0.0034). Angioplasty was shown to treat 33% of the cases of CM seen at implant, and these treated cases overwhelmingly had a positive outcome (P<0.001).<br />Conclusion: The use of OCT to assess CM of flow diverters has been shown to be predictive of the 30 day healing rate of an animal model of aneurysms.<br />Competing Interests: Competing interests: JC has received educational scholarships from Medtronic Neurovascular and Microvention/Terumo. JMW is employed by Medtronic Neurovascular. MJG has been a consultant on a fee-per-hour basis for Codman Neurovascular, InNeuroCo, Medtronic Neurovascular, and Stryker Neurovascular; holds stock in InNeuroCo; and has received research support from the National Institutes of Health (NIH), Anaconda, Codman Neurovascular, Gentuity, InNeuroCo, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Neuravi, Philips Healthcare, InNeuroCo, Rapid Medical, R92M, Stryker Neurovascular, The Stroke Project, and the Wyss Institute. ASP has been a consultant on a fee-per-hour basis for Medtronic Neurovascular and Stryker Neurovascular; and has received research grants from Medtronic Neurovascular and Stryker Neurovascular.<br /> (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Subjects :
- Animals
Blood Vessel Prosthesis adverse effects
Blood Vessel Prosthesis trends
Endovascular Procedures instrumentation
Endovascular Procedures methods
Female
Male
Rabbits
Self Expandable Metallic Stents adverse effects
Time Factors
Disease Models, Animal
Intracranial Aneurysm diagnostic imaging
Intracranial Aneurysm therapy
Self Expandable Metallic Stents trends
Tomography, Optical Coherence methods
Subjects
Details
- Language :
- English
- ISSN :
- 1759-8486
- Volume :
- 10
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of neurointerventional surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29127197
- Full Text :
- https://doi.org/10.1136/neurintsurg-2017-013502