OBJECT: Flow diverters (FDs) are increasingly used to treat complex intracranial aneurysms, but preclinical studies that could guide clinical applications are lacking. The authors designed a modular aneurysm model in canines to address this problem. METHODS: Three variants of one modular aneurysm model were constructed in 21 animals. Sidewall (n=5), curved sidewall (n=5), and end-wall bifurcation (n=7) aneurysms were treated with prototype 36-wire FDs. Four more end-wall bifurcation aneurysms were treated with prototype 48-wire lower-porosity FDs. Angiographic results postimplantation and at 3 months were scored with an ordinal scale. Animals were euthanized at 3 (n=17) or 6 (n=3) months, and the FD covering the aneurysm ostium was photographed to analyze metallic porosity and amount of neointima formation. RESULTS: Straight sidewall aneurysms were better occluded than curved sidewall and end-wall bifurcation aneurysms at the 3-month angiography follow-up (p=0.010). Flow diverters failed to occlude curved sidewall aneurysms (n=0/5) and all but one (n=1/7) end-wall bifurcation aneurysm. Angiographic results were no better (n=0/4) using a 48-wire FD (p=0.788). Branches jailed by the FD (n=16) remained patent in all cases. Metallic porosity was decreased (p=0.014) and neointimal closure of the aneurysm ostium was more complete (p=0.040) in sidewall aneurysms than in curved or bifurcation variants of the model. CONCLUSIONS: Flow diverters may succeed in treating straight sidewall aneurysms, but the same device repeatedly fails to occlude curved sidewall and end-wall bifurcation aneurysms. In vivo studies can be designed to test basic principles that, once validated, may serve to guide clinical use of new devices.
OBJECT: Flow diverters (FDs) are increasingly used to treat complex intracranial aneurysms, but preclinical studies that could guide clinical applications are lacking. The authors designed a modular aneurysm model in canines to address this problem. METHODS: Three variants of one modular aneurysm model were constructed in 21 animals. Sidewall (n=5), curved sidewall (n=5), and end-wall bifurcation (n=7) aneurysms were treated with prototype 36-wire FDs. Four more end-wall bifurcation aneurysms were treated with prototype 48-wire lower-porosity FDs. Angiographic results postimplantation and at 3 months were scored with an ordinal scale. Animals were euthanized at 3 (n=17) or 6 (n=3) months, and the FD covering the aneurysm ostium was photographed to analyze metallic porosity and amount of neointima formation. RESULTS: Straight sidewall aneurysms were better occluded than curved sidewall and end-wall bifurcation aneurysms at the 3-month angiography follow-up (p=0.010). Flow diverters failed to occlude curved sidewall aneurysms (n=0/5) and all but one (n=1/7) end-wall bifurcation aneurysm. Angiographic results were no better (n=0/4) using a 48-wire FD (p=0.788). Branches jailed by the FD (n=16) remained patent in all cases. Metallic porosity was decreased (p=0.014) and neointimal closure of the aneurysm ostium was more complete (p=0.040) in sidewall aneurysms than in curved or bifurcation variants of the model. CONCLUSIONS: Flow diverters may succeed in treating straight sidewall aneurysms, but the same device repeatedly fails to occlude curved sidewall and end-wall bifurcation aneurysms. In vivo studies can be designed to test basic principles that, once validated, may serve to guide clinical use of new devices.
Authors: Ronak J Dholakia; Ari D Kappel; Andrew Pagano; Henry H Woo; Baruch B Lieber; David J Fiorella; Chander Sadasivan Journal: Interv Neuroradiol Date: 2017-12-14 Impact factor: 1.610
Authors: Robert Fahed; Tim E Darsaut; Jean-Christophe Gentric; Behzad Farzin; Igor Salazkin; Guylaine Gevry; Jean Raymond Journal: Neuroradiology Date: 2017-02-27 Impact factor: 2.804
Authors: Jennifer N Rodriguez; Wonjun Hwang; John Horn; Todd L Landsman; Anthony Boyle; Mark A Wierzbicki; Sayyeda M Hasan; Douglas Follmer; Jesse Bryant; Ward Small; Duncan J Maitland Journal: J Biomed Mater Res A Date: 2014-08-04 Impact factor: 4.396
Authors: D N Gherasim; B Gory; R Sivan-Hoffmann; L Pierot; H Raoult; J-Y Gauvrit; H Desal; X Barreau; D Herbreteau; R Riva; F Ambesi Impiombato; X Armoiry; F Turjman Journal: AJNR Am J Neuroradiol Date: 2015-03-19 Impact factor: 3.825
Authors: T E Darsaut; J-C Gentric; C M McDougall; G Gevry; D Roy; A Weill; J Raymond Journal: AJNR Am J Neuroradiol Date: 2015-01-15 Impact factor: 3.825