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Yang L, Hao X, Gao B, Ren C, Du H, Su X, Zhang D, Bao T, Qiao Z, Cao Q. Endothelialization of PTFE-covered stents for aneurysms and arteriovenous fistulas created in canine carotid arteries. Sci Rep 2024; 14:4803. [PMID: 38413764 PMCID: PMC10899654 DOI: 10.1038/s41598-024-55532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/24/2024] [Indexed: 02/29/2024] Open
Abstract
To investigate the endothelialization of covered and bare stents deployed in the canine carotid arteries and subclavian arteries for treating experimental aneurysms and arteriovenous fistulas, twenty aneurysms were created in 10 dogs, and 20 fistulas in another 10 dogs. The Willis balloon-expandable covered stent and a self-expandable covered stent were used to treat these lesions, and a self-expandable bare stent was deployed in the subclavian artery for comparison. Followed up for up to 12 months, the gross observation, pathological staining, and scanning electronic microscopic data were analyzed. Two weeks after creation of animal model, thirty self-expandable covered stents and ten balloon-expandable covered stents were deployed. Fifteen bare stents were deployed within the left subclavian arteries. Twenty days after stenting, the aneurysm significantly shrank. At 6 months, the thrombi within the aneurysm cavity were organized. Three to 12 months later, most covered and bare stents were covered by a thin transparent or white layer of endothelial intima. Layers of intima or pseudomembrane were formed on the stent 20-40 days after stent deployment. Over three months, the pseudomembrane became organized, thinner, and merged into the vascular wall. Under scanning electronic microscopy, the surface of covered and bare stents had only deposition of collagen fibers and rare endothelial cells 20-40 days after stenting. From three to ten months, the endothelial cells on the internal surface of stent became mature, with spindle, stripe-like or quasi round morphology along the blood flow direction. Over time, the endothelial cells became mature. In conclusion, three months after deployment in canines' arteries, the self-expandable bare and covered stents have mostly been covered by endothelial cells which become maturer over time, whereas the balloon-expandable covered stents do not have complete coverage of endothelial cells at three months, especially for protruding stent struts and areas. Over time, the endothelialization will become mature.
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Affiliation(s)
- Lei Yang
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China.
| | - Xiaohong Hao
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China
| | - Bulang Gao
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China
| | - Chunfeng Ren
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China
| | - Hong Du
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China
| | - XianHui Su
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China
| | - Dongliang Zhang
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China
| | - Tong Bao
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China
| | - Zongrong Qiao
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China
| | - Qinying Cao
- Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, People's Republic of China.
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Grüter BE, Canzanella G, Hägler J, Rey J, Wanderer S, von Gunten M, Galvan JA, Grobholz R, Widmer HR, Remonda L, Andereggen L, Marbacher S. Topographic distribution of inflammation factors in a healing aneurysm. J Neuroinflammation 2023; 20:182. [PMID: 37533024 PMCID: PMC10394867 DOI: 10.1186/s12974-023-02863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Healing of intracranial aneurysms following endovascular treatment relies on the organization of early thrombus into mature scar tissue and neointima formation. Activation and deactivation of the inflammation cascade plays an important role in this process. In addition to timely evolution, its topographic distribution is hypothesized to be crucial for successful aneurysm healing. METHODS Decellularized saccular sidewall aneurysms were created in Lewis rats and coiled. At follow-up (after 3 days (n = 16); 7 days (n = 19); 21 days (n = 8)), aneurysms were harvested and assessed for healing status. In situ hybridization was performed for soluble inflammatory markers (IL6, MMP2, MMP9, TNF-α, FGF23, VEGF), and immunohistochemical analysis to visualize inflammatory cells (CD45, CD3, CD20, CD31, CD163, HLA-DR). These markers were specifically documented for five regions of interest: aneurysm neck, dome, neointima, thrombus, and adjacent vessel wall. RESULTS Coiled aneurysms showed enhanced patterns of thrombus organization and neointima formation, whereas those without treatment demonstrated heterogeneous patterns of thrombosis, thrombus recanalization, and aneurysm growth (p = 0.02). In coiled aneurysms, inflammation markers tended to accumulate inside the thrombus and in the neointima (p < 0.001). Endothelial cells accumulated directly in the neointima (p < 0.0001), and their presence was associated with complete aneurysm healing. CONCLUSION The presence of proinflammatory cells plays a crucial role in aneurysm remodeling after coiling. Whereas thrombus organization is hallmarked by a pronounced intra-thrombotic inflammatory reaction, neointima maturation is characterized by direct invasion of endothelial cells. Knowledge concerning topographic distribution of regenerative inflammatory processes may pave the way for future treatment modalities which enhance aneurysm healing after endovascular therapy.
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Affiliation(s)
- Basil E Grüter
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, C/o NeuroResearch Office,Tellstrasse 1, 5001, Aarau, Switzerland.
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland.
| | - Gwendoline Canzanella
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Joshua Hägler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Jeannine Rey
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Michael von Gunten
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Institute of Pathology Laenggasse, Ittigen, Switzerland
| | - José A Galvan
- Translational Research Unit (TRU), Institute of Pathology, University of Bern, Bern, Switzerland
| | - Rainer Grobholz
- Institute of Pathology, Kantonsspital Aarau, Aarau, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Hans-Rudolf Widmer
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, C/o NeuroResearch Office,Tellstrasse 1, 5001, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
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Rinaldo L, Arturo Larco JL, Kadirvel R, Kallmes DF. Aneurysm healing after endovascular treatment in the Helsinki sidewall aneurysm model: a systematic review. J Neurointerv Surg 2023; 15:298-302. [PMID: 36220336 DOI: 10.1136/jnis-2022-019448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 11/03/2022]
Abstract
AIMS Intracranial aneurysms are treated with a variety of endovascular devices including coils, stents, and flow diverters. The mechanisms by which these devices result in aneurysm occlusion and subsequent healing have been the subject of significant research using various animal models. The murine Helsinki aneurysm model is a sidewall aneurysm created by the end-to-side anastomosis of a donor aortic graft onto the abdominal aorta of a recipient animal. The aim of this systematic review is to assess the efficacy of different endovascular devices for the treatment of the Helsinki model aneurysm. METHODS We performed a systematic review of Pubmed in accordance with PRISMA guidelines, yielding eight studies detailing the results of endovascular treatment of this preclinical aneurysm model. Studies were included if they provided rates of complete aneurysm occlusion after treatment. RESULTS In these studies, aneurysms were treated with coiling (n=81, 7 studies), stenting (n=67, 3 studies), stent-coiling (n=13, 1 study), and flow diversion (n=49, 2 studies). The results of each individual study are discussed with the goal of providing a measure of the relative efficacy of different endovascular devices for the treatment of this particular model aneurysm. We also pay special attention to insights into the mechanisms underlying aneurysm healing after different forms of endovascular therapy. CONCLUSION The data presented here may be useful to investigators attempting to demonstrate superiority of novel endovascular devices relative to previous device iterations using this preclinical model.
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Affiliation(s)
- Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, New York, USA .,Department of Neurosurgery, University of California San Francisco, San Francisco, Northern California, USA
| | | | - Ramanathan Kadirvel
- Department of Neurosurgery, Mayo Clinic, Rochester, New York, USA.,Radiology, Mayo Clinic, Rochester, Minnesota, USA
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