A mini-review of intrasaccular flow diverters

Hecker, Constantin; Müller-Thies-Broussalis, Erasmia; Griessenauer, Christoph J.; Killer‐Oberpfalzer, Monika

doi:10.1136/neurintsurg-2021-018426

Cited by 14 publications

(10 citation statements)

References 58 publications

(80 reference statements)

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“…These features lead to aneurysm occlusion after FDD placement due to modification of intraaneurysmal hemodynamics and neointimal endothelialization [ 2 ]. However, these characteristics also pose considerable drawbacks in particular the strict requirements for dual antiplatelet therapy and the risk of ischemic complications after FDD placement [ 3 ]. According to several large studies on flow diverters, the incidence of ischemic stroke varies from 4.7 to 10% [ 4 – 8 ].…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…The Neqstent device is a derivative of the CNS. After positioning at the neck of an aneurysm, the coiling microcatheter crosses the mesh into the aneurysm ( 61 , 62 ). The Neqstent device stays within the aneurysm neck and maintains the coils within the aneurysm ( 85 ).…”

Section: New Devicesmentioning

confidence: 99%

“…Luna named Artisse in the newest version ( 5 , 62 ). Previous studies showed that the Luna/Artisse embolization system was safe and effective ( 86 , 87 ).…”

Section: New Devicesmentioning

confidence: 99%

Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects

Zhou,

Lan,

2023

Front. Neurol.

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Middle cerebral artery (MCA) aneurysms are complex and widely distributed throughout the course of the MCA. Various types of aneurysms can occur in the MCA. Ruptured as well as unruptured MCA aneurysms may require treatment to avoid bleeding or rebleeding. Currently, clipping is regarded as the first-line choice for the treatment of MCA aneurysms. However, endovascular treatment (EVT) is emerging as an alternative treatment in selected cases. EVT techniques vary. Therefore, it is necessary to review EVT for MCA aneurysms. In this review, the following issues were discussed: MCA anatomy and anomalies, classifications of MCA aneurysms, the natural history of MCA aneurysms, EVT status and principle, deployments of traditional coiling techniques and flow diverters (FDs), and deployments and prospects of intrasaccular flow disruptors and stent-like devices. According to the review and our experience, traditional coiling EVT is still the preferred therapy for most MCA aneurysms. FD deployment can be used in selective MCA aneurysms. Parent artery occlusion (PAO) can be used to treat distal MCA aneurysms. In addition, new devices can be used to treat MCA aneurysms, such as intrasaccular flow disruptors and stent-like devices. In general, EVT is gaining popularity as an alternative treatment option; however, there is still a lack of evidence regarding EVT, and longer-term data are not currently available for most EVT devices.

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“…nruptured intracranial aneurysms are rather common lesions that are now being diagnosed early as a result of the expansion of noninvasive intracranial vascular imaging techniques. [1][2][3][4][5] With the advent of flow diversion therapy during the past few decades, the goal of endovascular aneurysm treatments has changed conceptually from parent vessel sacrifice or coil packing of the aneurysm fundus to endoluminal restoration of the parent vessel using flow diverters. 1,[5][6][7] The endoluminal devices used for this purpose change the nature of fluid exchange between the aneurysm and parent artery, which consequently facilitates aneurysmal sac thrombosis.…”

mentioning

confidence: 99%

“…[5][6][7] By doing this, they make it possible to repair the parent artery's mural insufficiency, occluding the aneurysm permanently and resolving it over. [1][2][3][4][5]8,9 The 2 Food and Drug Administration-approved flow diverters, pipeline embolization device (PED) and flow redirection endoluminal device (FRED), have demonstrated excellent results in treating unruptured aneurysms in numerous studies conducted internationally, enabling minimally invasive therapy of intracranial aneurysms. [2][3][4][7][8][9][10][11][12][13] The potential for these devices to target and treat aneurysms of diverse sizes, shapes, and even different cerebral sites that have not yet been thoroughly submitted to prospective investigation is quite promising.…”

mentioning

confidence: 99%

Commentary: Comparison of Flow-Redirection Endoluminal Device and Pipeline Embolization Device in the Treatment of Intracerebral Aneurysms

Dagra

Lucke‐Wold

2022

Neurosurgery

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A mini-review of intrasaccular flow diverters

Cited by 14 publications

References 58 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

Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects

Commentary: Comparison of Flow-Redirection Endoluminal Device and Pipeline Embolization Device in the Treatment of Intracerebral Aneurysms

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