Document Detail


Stents and flow diverters in the treatment of aneurysms: device deformation in vivo may alter porosity and impact efficacy.
MedLine Citation:
PMID:  22895818     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: High-porosity (HP) and flow-diverting (FD) stents are increasingly used to treat intracranial aneurysms. In vivo device deformations and their impact on the porosity of the segment of device lying over the aneurysm neck remain inadequately characterized. METHODS: Porosities of different braided FDs were studied in straight and 90° curved glass tubes. In vivo, 11 experimental lateral wall aneurysms were treated with FD (n = 7) or HP (n = 4) stents. At 3 months, the segment of FDs and HP stents over the aneurysm neck was analyzed, paying attention to changes in device diameter, metallic porosity, and neointimal closure of pores over the aneurysm or branch ostia. Device deformations were reproduced with benchtop experiments. RESULTS: In 90° curved tubes, FD porosity was higher (P = 0.025) and pore density was lower (P = 0.01) on convex compared to concave surfaces, but variations remained within 5-10 %. After in vivo deployment, a spindle-shaped deformation of FDs occurred, with focal expansion at the level of the aneurysm neck (P = 0.004). This deformation translated into an accordion-like distribution of stent struts across the aneurysm neck, where porosity was not uniform. The midsection of the aneurysm ostium had more metal coverage than adjacent ostial areas (P = 0.002). Mean porosity over the aneurysm neck was 78 ± 9.4 and 32.6 ± 12.1 % for HP and FD stents, respectively (P = 0.008), decreasing to 13.0 ± 10.1 and 1.4 ± 0.6 % (P = 0.022) following neointimal coverage, respectively. Spindle-shaped deformations and accordion effects were reproduced with benchtop manipulations; fluctuations in porosity and diameter changes correlated closely (R = 0.81; P = 0.005). CONCLUSION: Alterations in porosity may occur following in vivo implantation.
Authors:
Fabrice Bing; Tim E Darsaut; Igor Salazkin; Alina Makoyeva; Guylaine Gevry; Jean Raymond
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-16
Journal Detail:
Title:  Neuroradiology     Volume:  -     ISSN:  1432-1920     ISO Abbreviation:  Neuroradiology     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Service de Neuroradiologie, CHRU Strasbourg, Strasbourg, France.
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