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Pielenz D, Klisch J, Fiorella D, Gawlitza M, Steinbrecher A, Leinisch E, Lobsien E, Hoffmann KT, Lobsien D. The pEGASUS-HPC stent system for intracranial arterial stenosis: a single-center case series. J Neurointerv Surg 2024:jnis-2024-021737. [PMID: 38760166 DOI: 10.1136/jnis-2024-021737] [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: 03/21/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Intracranial arterial stenting is a technique for the treatment of symptomatic stenosis. In this single-center retrospective case series we evaluated a novel low profile laser-cut stent with an antithrombogenic hydrophilic polymer coating (pEGASUS-HPC, Phenox GmbH, Bochum, Germany) for the treatment of intracranial stenosis in the setting of acute ischemic stroke and elective cases. METHODS All patients treated with pEGASUS-HPC for one or more intracranial arterial stenoses at our institution were retrospectively included. Clinical, imaging and procedural parameters as well as clinical and imaging follow-up data were collected. RESULTS We performed 43 interventions in 41 patients with 42 stenoses in our neurovascular center between August 2021 and February 2024. Twenty-one patients (51.2%) were female and the mean±SD age was 71±10.8 years. Thirty-seven (86.1%) procedures were performed in the setting of endovascular acute ischemic stroke treatment. Technical or procedural complications occurred in seven patients (16.3%), six in the thrombectomy group and one in the elective group. One stent-related hemorrhagic complication (subarachnoid hemorrhage) occurred in emergency cases and symptomatic intracerebral hemorrhage occurred in one patient treated in an elective setting. Overall stenosis reduction following pEGASUS-HPC stent implantation was 53.0±18.0%. On follow-up imaging, which was available for 16 patients (37.2%) after an average of 32±58.6 days, 62.5% of the stents were patent. CONCLUSION Our single-center case series demonstrates the feasibility of using the pEGASUS-HPC stent system, especially in emergency situations when thrombectomy fails.
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Affiliation(s)
- Daniel Pielenz
- Department of Neuroradiology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Joachim Klisch
- Department of Neuroradiology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
- Department of Neuroradiology, Helios Vogtland Hospital Plauen, Plauen, Sachsen, Germany
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - Matthias Gawlitza
- University Hospital Leipzig Institute for Neuroradiology, Leipzig, Sachsen, Germany
| | | | - Elke Leinisch
- Department of Neurology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Elmar Lobsien
- Department of Neurology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Karl-Titus Hoffmann
- University Hospital Leipzig Institute for Neuroradiology, Leipzig, Sachsen, Germany
| | - Donald Lobsien
- Department of Neuroradiology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
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2
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Maitz MF, Kaiser DPO, Cuberi A, Weich Hernández R, Mühl-Benninghaus R, Tomori T, Gawlitza M. Enhancing thromboresistance of neurovascular nickel-titanium devices with responsive heparin hydrogel coatings. J Neurointerv Surg 2024:jnis-2024-021836. [PMID: 38760168 DOI: 10.1136/jnis-2024-021836] [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: 04/08/2024] [Accepted: 05/01/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Neurointerventional devices, particularly laser-cut thin-strut stents made of self-expanding nickel-titanium alloy, are increasingly utilized for endovascular applications in intracranial arteries and dural venous sinuses. Preventing thrombosis and stroke necessitates systemic anticoagulant and antiplatelet therapies with the risk of bleeding complications. Antithrombotic coatings present a promising solution. METHODS In this study, we investigated the potential of hydrogels composed of four-armed poly(ethylene glycol) (starPEG) and heparin, with or without coagulation-responsive heparin release, as coatings for neurovascular devices to mitigate blood clot formation. We evaluated the feasibility and efficacy of these coatings on neurovascular devices through in vitro Chandler-Loop assays and implantation experiments in the supra-aortic arteries of rabbits. RESULTS Stable and coagulation-responsive starPEG-heparin hydrogel coatings exhibited antithrombotic efficacy in vitro, although with a slightly reduced thromboprotection observed in vivo. Furthermore, the hydrogel coatings demonstrated robustness against shear forces encountered during deployment and elicited only marginal humoral and cellular inflammatory responses compared with the reference standards. CONCLUSION Heparin hydrogel coatings offer promising benefits for enhancing the hemocompatibility of neurointerventional devices made of self-expanding nickel-titanium alloy. The variance in performance between in vitro and in vivo settings may be attributed to differences in low- and high-shear blood flow conditions inherent to these models. These models may represent the differences in venous and arterial systems. Further optimization is warranted to tailor the hydrogel coatings for improved efficacy in arterial applications.
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Affiliation(s)
- Manfred F Maitz
- Max Bergmann Center of Biomaterials, Leibniz Institute of Polymer Research Dresden, Dresden, Sachsen, Germany
| | - Daniel P O Kaiser
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Ani Cuberi
- Institute of Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rafaela Weich Hernández
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, Germany
| | | | - Toshiki Tomori
- Department of Diagnostic and Interventional Neuroradiology, University Medical School of Saarland, Homburg/Saar, Germany
| | - Matthias Gawlitza
- Institute of Neuroradiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
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de Castro-Afonso LH, Machado JP, Nakiri GS, Abud TG, Monsignore LM, Freitas RK, de Oliveira RS, Colli BO, Abud DG. Two year follow-up of distal unruptured intracranial aneurysms treated with a surface modified flow diverter under prasugrel monotherapy. J Neurointerv Surg 2023:jnis-2023-020397. [PMID: 37524519 DOI: 10.1136/jnis-2023-020397] [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: 04/02/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND A new generation of modified surface flow diverters (FDs) and monotherapy using new antiplatelets may reduce both ischemic and hemorrhagic complications during the treatment of intracranial aneurysms. Previous preliminary safety analysis of distal unruptured intracranial aneurysms treated with the FD p48 MW HPC (phenox-Wallaby, Bochum, Germany) under antiplatelet monotherapy with prasugrel showed promising results. However, the long term outcomes of distal intracranial aneurysms treated with FDs under antiplatelet monotherapy are not known. METHODS This was a single center, prospective, pivotal, open single arm study. The primary (safety) endpoint was absence of any new neurological deficits after treatment until the 24 month follow-up. The primary (efficacy) endpoint was the incidence of complete aneurysm occlusion 24 months after treatment. The secondary (efficacy) endpoints were any incidence of aneurysm dome reduction 24 months after treatment. RESULTS 21 patients harboring 27 distal aneurysms of the anterior circulation were included. No patient had neurologic deficits in the time from treatment to the 24 month follow-up. Complete aneurysm occlusion occurred in 20 (74%) of 27 aneurysms at the 24 month follow-up. Four aneurysms (14.8%) had dome reduction, and three aneurysms (11.1%) remained unchanged. CONCLUSIONS In this pilot trial, treatment of distal unruptured intracranial aneurysms with an FD under monotherapy with prasugrel, followed by monotherapy with aspirin, appeared to be safe and effective. Randomized studies with long term follow-up are needed to confirm these results.
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Affiliation(s)
- Luis Henrique de Castro-Afonso
- Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
| | - João Paulo Machado
- Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
| | - Guilherme Seizem Nakiri
- Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
| | - Thiago Giansante Abud
- Interventional Neuroradiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Lucas Moretti Monsignore
- Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
| | - Rafael Kiyuze Freitas
- Interventional Neuroradiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
| | - Daniel Giansante Abud
- Interventional Neuroradiology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
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Popovich KD, Vagner SA, Murashko DT, Ten GN, Ryabkin DI, Savelyev MS, Kitsyuk EP, Gerasimenko EA, Edelbekova P, Konovalov AN, Telyshev DV, Selishchev SV, Gerasimenko AY. Stability and Thrombogenicity Analysis of Collagen/Carbon Nanotube Nanocomposite Coatings Using a Reversible Microfluidic Device. MEMBRANES 2023; 13:403. [PMID: 37103830 PMCID: PMC10144663 DOI: 10.3390/membranes13040403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
Abstract
Currently, the development of stable and antithrombogenic coatings for cardiovascular implants is socially important. This is especially important for coatings exposed to high shear stress from flowing blood, such as those on ventricular assist devices. A method of layer-by-layer formation of nanocomposite coatings based on multi-walled carbon nanotubes (MWCNT) in a collagen matrix is proposed. A reversible microfluidic device with a wide range of flow shear stresses has been developed for hemodynamic experiments. The dependence of the resistance on the presence of a cross-linking agent for collagen chains in the composition of the coating was demonstrated. Optical profilometry determined that collagen/c-MWCNT and collagen/c-MWCNT/glutaraldehyde coatings obtained sufficiently high resistance to high shear stress flow. However, the collagen/c-MWCNT/glutaraldehyde coating was almost twice as resistant to a phosphate-buffered solution flow. A reversible microfluidic device made it possible to assess the level of thrombogenicity of the coatings by the level of blood albumin protein adhesion to the coatings. Raman spectroscopy demonstrated that the adhesion of albumin to collagen/c-MWCNT and collagen/c-MWCNT/glutaraldehyde coatings is 1.7 and 1.4 times lower than the adhesion of protein to a titanium surface, widely used for ventricular assist devices. Scanning electron microscopy and energy dispersive spectroscopy determined that blood protein was least detected on the collagen/c-MWCNT coating, which contained no cross-linking agent, including in comparison with the titanium surface. Thus, a reversible microfluidic device is suitable for preliminary testing of the resistance and thrombogenicity of various coatings and membranes, and nanocomposite coatings based on collagen and c-MWCNT are suitable candidates for the development of cardiovascular devices.
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Affiliation(s)
- Kristina D. Popovich
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street 2-4, 119435 Moscow, Russia
- Institute of Biomedical Systems, National Research University of Electronic Technology, Shokin Square 1, Zelenograd, 124498 Moscow, Russia
| | - Sergey A. Vagner
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street 2-4, 119435 Moscow, Russia
| | - Denis T. Murashko
- Institute of Biomedical Systems, National Research University of Electronic Technology, Shokin Square 1, Zelenograd, 124498 Moscow, Russia
| | - Galina N. Ten
- Department of Physics, Saratov State University, Astrakhanskaya Street 83, 410012 Saratov, Russia
| | - Dmitry I. Ryabkin
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street 2-4, 119435 Moscow, Russia
- Institute of Biomedical Systems, National Research University of Electronic Technology, Shokin Square 1, Zelenograd, 124498 Moscow, Russia
| | - Mikhail S. Savelyev
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street 2-4, 119435 Moscow, Russia
- Institute of Biomedical Systems, National Research University of Electronic Technology, Shokin Square 1, Zelenograd, 124498 Moscow, Russia
| | - Evgeny P. Kitsyuk
- Scientific-Manufacturing Complex “Technological Centre”, Shokin Square 1, bld. 7 off. 7237, 124498 Moscow, Russia
| | - Ekaterina A. Gerasimenko
- Institute of Biomedical Systems, National Research University of Electronic Technology, Shokin Square 1, Zelenograd, 124498 Moscow, Russia
- Orthopedic Department, State Autonomous Institution of Health of the City of Moscow, Dental Clinic No.35, Building 1638, Zelenograd, 124365 Moscow, Russia
| | - Polina Edelbekova
- Insitute of Nanotechnology of Microelectronics of the Russian Academy of Sciences, 32a Leninsky Av., 119991 Moscow, Russia
| | | | - Dmitry V. Telyshev
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street 2-4, 119435 Moscow, Russia
- Institute of Biomedical Systems, National Research University of Electronic Technology, Shokin Square 1, Zelenograd, 124498 Moscow, Russia
| | - Sergey V. Selishchev
- Institute of Biomedical Systems, National Research University of Electronic Technology, Shokin Square 1, Zelenograd, 124498 Moscow, Russia
| | - Alexander Yu. Gerasimenko
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street 2-4, 119435 Moscow, Russia
- Institute of Biomedical Systems, National Research University of Electronic Technology, Shokin Square 1, Zelenograd, 124498 Moscow, Russia
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Srivastava A, Kumari N, Agarwal M, Bhati P, Bhatnagar N. Fabrication and characterization of bioresorbable radiopaque PLLA/PCL/Mg alloy composite tubes for cardiovascular stent application. INT J POLYM MATER PO 2023. [DOI: 10.1080/00914037.2023.2182783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- Alok Srivastava
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Nisha Kumari
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Mohit Agarwal
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Pooja Bhati
- Department of Mechanical and Automation Engineering, Indira Gandhi Delhi Technical University for Women, New Delhi, India
| | - Naresh Bhatnagar
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
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6
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Morales-Caba L, Lylyk I, Vázquez-Añón V, Bleise C, Scrivano E, Perez N, Lylyk PN, Lundquist J, Bhogal P, Lylyk P. The pCONUS2 and pCONUS2 HPC Neck Bridging Devices : Results from an International Multicenter Retrospective Study. Clin Neuroradiol 2023; 33:129-136. [PMID: 35819477 PMCID: PMC10014770 DOI: 10.1007/s00062-022-01191-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bifurcation aneurysms represent an ongoing endovascular challenge with a variety of techniques and devices designed to address them. We present our multicenter series of the pCONUS2 and pCONUS2 HPC devices when treating bifurcation aneurysms. METHODS We performed a retrospective review of our prospectively maintained databases at 3 tertiary neurointerventional centers to identify all patients who underwent coil embolization with the pCONUS2 or pCONUS2 HPC device between February 2015 and August 2021. We recorded baseline demographics, aneurysm data, complications, immediate and delayed angiographic results. RESULTS We identified 55 patients with 56 aneurysms, median age 63 years (range 42-78 years), 67.3% female (n = 37). The commonest aneurysm location was the MCA bifurcation (n = 40, 71.4%). Average dome height was 8.9 ± 4.2 mm (range 3.2-21.5 mm), average neck width 6.4 ± 2.5 mm (range 2.6-14 mm), and average aspect ratio 1.3 ± 0.6 (range 0.5-3.3). The pCONUS2 was used in 64.3% and the pCONUS2 HPC in 35.7%. The procedural technical success rate was 98.2%. Intraoperative complications occurred in 5 cases (8.9%), 4 of which were related to the coils with partial thrombus formation on the pCONUS2 HPC seen in 1 case that was resolved with heparin. In relation to the procedure and treatment of the aneurysm the overall permanent morbidity was 1.8% (n = 1/55) and mortality 0%. Delayed angiographic follow-up (48 aneurysms) at median 12 months postprocedure (range 3-36 months) demonstrated adequate occlusion of 83.4% of aneurysms. CONCLUSION The pCONUS2 and pCONUS2 HPC devices carry a high technical success rate, low complication and retreatment rate, and good rates of adequate occlusion. Larger prospective confirmatory studies are required.
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Affiliation(s)
- L Morales-Caba
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - I Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - V Vázquez-Añón
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - C Bleise
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - E Scrivano
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - N Perez
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P N Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - J Lundquist
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, Whitechapel Road, E1 1BB, London, UK.
| | - P Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
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Zięba M, Rusak T, Misztal T, Zięba W, Marcińczyk N, Czarnecka J, Al-Gharabli S, Kujawa J, Terzyk AP. Nitrogen plasma modification boosts up the hemocompatibility of new PVDF-carbon nanohorns composite materials with potential cardiological and circulatory system implants application. BIOMATERIALS ADVANCES 2022; 138:212941. [PMID: 35913257 DOI: 10.1016/j.bioadv.2022.212941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
To design new material for blood-related applications one needs to consider various factors such as cytotoxicity, platelet adhesion, or anti-thrombogenic properties. The aim of this work is the design of new, highly effective materials possessing high blood compatibility. To do this, the new composites based on the poly(vinylidene fluoride) (PVDF) support covered with a single-walled carbon nanohorns (CNHs) layer were prepared. The PVDF-CNHs composites were subsequently used for the first time in the hemocompatibility studies. To raise the hemocompatibility a new, never applied before for CNHs, plasma-surface modifications in air, nitrogen and ammonia were implemented. This relatively cheap, facile and easy method allows generating the new hybrid materials with high effectiveness and significant differences in surface properties (water contact angle, surface ζ-potential, and surface functional groups composition). Changing those properties made it possible to select the most promising samples for blood-related applications. This was done in a fully controlled way by applying Taguchi's "orthogonal array" procedure. It is shown for the first time that nitrogen plasma treatment of new surfaces is the best tool for hemocompatibility rise and leads to very low blood platelet adhesion, no cytotoxicity, and excellent performance in thromboelastometry and hemolysis tests. We propose a possible mechanism explaining this behavior. The optimisation results are coherent with biological characterisation and are supported with Hansen Solubility Parameters. New surfaces can find potential applications in cardiological and circulatory system implants as well as other blood-related biomaterials.
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Affiliation(s)
- Monika Zięba
- Faculty of Chemistry, Physicochemistry of Carbon Materials Research Group, Nicolaus Copernicus University in Toruń, Gagarina Street 7, 87-100 Toruń, Poland; Interdisciplinary PhD School "Academia Copernicana", Nicolaus Copernicus University in Toruń, Lwowska Street 1, 87-100 Toruń, Poland
| | - Tomasz Rusak
- Department of Physical Chemistry, Medical University of Bialystok, Adama Mickiewicza 2A, 15-089 Bialystok, Poland
| | - Tomasz Misztal
- Department of Physical Chemistry, Medical University of Bialystok, Adama Mickiewicza 2A, 15-089 Bialystok, Poland
| | - Wojciech Zięba
- Faculty of Chemistry, Physicochemistry of Carbon Materials Research Group, Nicolaus Copernicus University in Toruń, Gagarina Street 7, 87-100 Toruń, Poland; Interdisciplinary PhD School "Academia Copernicana", Nicolaus Copernicus University in Toruń, Lwowska Street 1, 87-100 Toruń, Poland
| | - Natalia Marcińczyk
- Department of Biopharmacy, Medical University of Bialystok, Adama Mickiewicza 2C, 15-089 Bialystok, Poland
| | - Joanna Czarnecka
- Department of Biochemistry, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Toruń, Lwowska Street 1, 87-100 Toruń, Poland
| | - Samer Al-Gharabli
- Pharmaceutical and Chemical Engineering Department, German Jordanian University, Amman 11180, Jordan
| | - Joanna Kujawa
- Faculty of Chemistry, Department of Physical Chemistry and Physicochemistry of Polymers, Nicolaus Copernicus University in Toruń, Gagarina Street 7, 87-100 Toruń, Poland.
| | - Artur P Terzyk
- Faculty of Chemistry, Physicochemistry of Carbon Materials Research Group, Nicolaus Copernicus University in Toruń, Gagarina Street 7, 87-100 Toruń, Poland.
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Gegenschatz-Schmid K, Buzzi S, Grossmann J, Roschitzki B, Urbanet R, Heuberger R, Glück D, Zucker A, Ehrbar M. Reduced thrombogenicity of surface-treated Nitinol implants steered by altered protein adsorption. Acta Biomater 2022; 137:331-345. [PMID: 34673227 DOI: 10.1016/j.actbio.2021.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022]
Abstract
Blood-contacting medical implants made of Nitinol and other titanium alloys, such as neurovascular flow diverters and peripheral stents, have the disadvantage of being highly thrombogenic. This makes the use of systemic (dual) anti-platelet/anticoagulant therapies inevitable with related risks of device thrombosis, bleeding and other complications. Meeting the urgent clinical demand for a less thrombogenic Nitinol surface, we describe here a simple treatment of standard, commercially available Nitinol that renders its surface ultra-hydrophilic and functionalized with phosphate ions. The efficacy of this treatment was assessed by comparing standard and surface-treated Nitinol disks and braids, equivalent to flow diverters. Static and dynamic (Chandler loop) blood incubation tests showed a drastic reduction of thrombus formation on treated devices. Surface chemistry and proteomic analysis indicated a key role of phosphate and calcium ions in steering blood protein adsorption and avoiding coagulation cascade activation and platelet adhesion. A good endothelialization of the surface confirmed the biocompatibility of the treated surface. STATEMENT OF SIGNIFICANCE: Titanium alloys such as Nitinol are biocompatible and show favorable mechanical properties, which led to their widespread use in medical implants. However, in contact with blood their surface triggers the activation of the intrinsic coagulation cascade, which may result in catastrophic thrombotic events. The presented results showed that a phosphate functionalization of the titanium oxide surface suppresses the activation of both coagulation cascade and platelets, avoiding the subsequent formation of a blood clot. This novel approach has therefore a great potential for mitigating the risks associated to either thrombosis or bleeding complications (due to systemic anticoagulation) in patients with cardiovascular implants.
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Mühl-Benninghaus R, Fries F, Kießling M, Tomori T, Krajewski S, Simgen A, Bauer S, Hey N, Brynda E, Taborska J, Riedel T, Reith W, Cattaneo G, Brochhausen C. Vascular Response on a Novel Fibrin-Based Coated Flow Diverter. Cardiovasc Intervent Radiol 2021; 45:236-243. [PMID: 34913987 PMCID: PMC8807434 DOI: 10.1007/s00270-021-03007-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
Purpose Due to thromboembolic complications and in-stent-stenosis after flow diverter (FD) treatment, the long-term use of dual antiplatelet treatment (DAPT) is mandatory. The tested nano-coating has been shown to reduce material thrombogenicity and promote endothelial cell proliferation in vitro. We compared the biocompatibility of coated (Derivo Heal) and non-coated (Derivo bare) FDs with DAPT in an animal model. Methods Derivo® bare (n = 10) and Derivo® Heal (n = 10) FD were implanted in the common carotid arteries (CCAs) of New Zealand white rabbits. One additional FD, alternately a Derivo bare (n = 5) or Derivo Heal (n = 5), was implanted in the abdominal aorta (AA) for assessment of the patency of branch arteries. Histopathological examinations were performed after 28 days. Angiography was performed before and after FD implantation and at follow-up. Results Statistical analysis of the included specimens showed complete endothelialization of all FDs with no significant differences in neointima thickness between Derivo® bare and Derivo® Heal (CCA: p = 0.91; AA: p = 0.59). A significantly reduced number of macrophages in the vessel wall of the Derivo Heal was observed for the CCA (p = 0.02), and significantly reduced fibrin and platelet deposition on the surface of the Derivo Heal was observed for the AA. All branch arteries of the stented aorta remained patent. Conclusion In this animal model, the novel fibrin-based coated FD showed a similar blood and tissue compatibility as the non-coated FD.
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Affiliation(s)
- Ruben Mühl-Benninghaus
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany.
| | - Frederik Fries
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany
| | - Mara Kießling
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany
| | - Stefanie Krajewski
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tübingen, Germany
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany
| | | | | | - Eduard Brynda
- Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Johanka Taborska
- Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Riedel
- Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany
| | - Giorgio Cattaneo
- Institute for Biomedical Engineering, University of Stuttgart, Stuttgart, Germany
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10
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Winters H, Schüngel MS, Scherlach C, Mucha D, Thalwitzer J, Härtig W, Donitza A, Bailis N, Maybaum J, Hoffmann KT, Quäschling U, Schob S. First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating. Front Neurol 2021; 12:724705. [PMID: 34594297 PMCID: PMC8476967 DOI: 10.3389/fneur.2021.724705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 12/23/2022] Open
Abstract
Background: In the last decade, flow diversion (FD) has been established as hemodynamic treatment for cerebral aneurysms arising from proximal and distal cerebral arteries. However, two significant limitations remain—the need for 0.027” microcatheters required for delivery of most flow diverting stents (FDS), and long-term dual anti-platelet therapy (DAPT) in order to prevent FDS-associated thromboembolism, at the cost of increasing the risk for hemorrhage. This study reports the experience of three neurovascular centers with the p64MW-HPC, a FDS with anti-thrombotic coating that is implantable via a 0.021” microcatheter. Materials and methods: Three neurovascular centers contributed to this retrospective analysis of patients that had been treated with the p64MW-HPC between March 2020 and March 2021. Clinical data, aneurysm characteristics, and follow-up results, including procedural and post-procedural complications, were recorded. The hemodynamic effect was assessed using the O'Kelly–Marotta Scale (OKM). Results: Thirty-two patients (22 female, mean age 57.1 years) with 33 aneurysms (27 anterior circulation and six posterior circulation) were successfully treated with the p64MW-HPC. In 30/32 patients (93.75%), aneurysmal perfusion was significantly reduced immediately post implantation. Follow-up imaging was available for 23 aneurysms. Delayed aneurysm perfusion (OKM A3: 8.7%), reduction in aneurysm size (OKM B1-3: 26.1%), or sufficient separation from the parent vessel (OKM C1-3 and D1: 65.2%) was demonstrated at the last available follow-up after a mean of 5.9 months. In two cases, device thrombosis after early discontinuation of DAPT occurred. One delayed rupture caused a caroticocavernous fistula. The complications were treated sufficiently and all patients recovered without permanent significant morbidity. Conclusion: Treatment with the p64MW-HPC is safe and feasible and achieves good early aneurysm occlusion rates in the proximal intracranial circulation, which are comparable to those of well-established FDS. Sudden interruption of DAPT in the early post-interventional phase can cause in-stent thrombosis despite the HPC surface modification. Deliverability via the 0.021” microcatheter facilitates treatment in challenging vascular anatomies.
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Affiliation(s)
- Helge Winters
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany.,Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Cordula Scherlach
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dirk Mucha
- Institut für Radiologie und Neuroradiologie, Heinrich-Braun- Klinikum, Zwickau, Germany
| | - Jörg Thalwitzer
- Institut für Radiologie und Neuroradiologie, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Wolfgang Härtig
- Paul-Flechsig-Institut für Hirnforschung, Universität Leipzig, Leipzig, Germany
| | - Aneta Donitza
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle, Halle (Saale), Germany
| | - Nikolaos Bailis
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Jens Maybaum
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Karl Titus Hoffmann
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulf Quäschling
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Stefan Schob
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle, Halle (Saale), Germany
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11
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Ruptured blister-type cerebral aneurysm pathogenesis and treatment with flow diversion using a novel antiplatelet agent cangrelor. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Bhogal P, Petrov A, Rentsenkhu G, Nota B, Ganzorig E, Regzengombo B, Jagusch S, Henkes E, Henkes H. Early clinical experience with the p48MW HPC and p64MW HPC flow diverters in the anterior circulation aneurysm using single anti-platelet treatment. Interv Neuroradiol 2021; 28:266-276. [PMID: 34233547 PMCID: PMC9178779 DOI: 10.1177/15910199211029503] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The p64MW HPC and p48MW HPC flow diverters have reduced thrombogenicity due
to hydrophilic coating. The purpose of this study was to evaluate its safety
and efficacy in Mongolian patients under single antiplatelet therapy (SAPT)
with prasugrel. Materials and methods We performed a retrospective review of patients enrolled into our
prospectively maintained database to identify all patients treated with
either the p48MW HPC or p64MW HPC under SAPT. We recorded baseline
demographics, aneurysm size and location, procedural complications,
angiographic and clinical results. Results 24 patients, (female = 21, 87.5%), age 48.2 ± 11.6 years (range 25–63)
underwent treatment of 30 aneurysms with either p64MW HPC or p48MW HPC. All
aneurysms were saccular with dome width 8.2 ± 6.5 (range 1.6–26.0 mm) and
dome height 7.6 ± 6.7 (range 1.6–30.0 mm). None of the aneurysms were
previously treated. The average PRU was 54.6 ± 31.2 (range 1–127) on
pre-operative VerifyNow testing. Angiographic follow-up was available for 13
patients (17 aneurysms), 183 ± 36 days post-procedure, at which point 64.7%
of aneurysms (n = 11/17) were completely occluded and 11.8% (n = 2/17) had
only neck remnants resulting in 76.5% of aneurysms being adequately occluded
A single intra-operative complication (4.2%) occurred however all patients
were mRS ≤1 at last follow-up. There were two post-operative complications
neither of which resulted in permanent neurological morbidity. There were no
instances of post-operative aneurysmal rupture or delayed parenchymal
haemorrhage. The overall mortality was 0%. Conclusion The efficacy and safety of p64MW HPC coated devices under SAPT is similar to
uncoated flow diverters that require DAPT.
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Affiliation(s)
| | - Andrey Petrov
- Vascular Neurosurgery Department, Russian Polenov Neurosurgical Institute, Branch of National Medical Research Center "Almazov", St. Petersburg, Russia
| | | | - Baatarjan Nota
- Department of Angiography, Shastin Central Hospital, Ulaanbaatar, Mongolia
| | - Erdenebat Ganzorig
- Department of Angiography, Shastin Central Hospital, Ulaanbaatar, Mongolia
| | | | | | - Elina Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany.,University Duisburg-Essen, Essen, Germany
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13
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Wu F, Wan Y, Wang L, Zhou L, Ma N, Qian W. Construction of Optical Interference Fibrin and Thrombolysis Analysis with Silica Colloidal Crystal Films. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2021; 37:7264-7272. [PMID: 34080427 DOI: 10.1021/acs.langmuir.1c01020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Developing powerful real-time methods for monitoring the thrombolytic process is highly desirable for the early therapy of thrombus diseases. Herein, an optical interference fibrin was constructed, fabricated by assembling a 190 nm silica colloidal crystal on glass slides, for detecting a thrombolytic process through the shift of interference peaks caused by the variation of the thicknesses of a silica colloidal crystal film with loaded fibrin dissolution. The whole kinetic progress of thrombolysis by nattokinase and urokinase as thrombolytic drug models was recorded, and the kinetic data were calculated. Moreover, the developed method shows excellent sensitivity for the activity of nattokinase and urokinase with wide linear ranges of approximately 0.75-750 and 5-1000 units mL-1, respectively. Thus, this method can be used as a real-time, low-cost, and simple system for monitoring the thrombolytic process of drugs, demonstrating huge potential in the development of treating thromboembolic diseases and screening drugs.
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Affiliation(s)
- Feng Wu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P. R. China
| | - Yizhen Wan
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P. R. China
| | - Lu Wang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P. R. China
| | - Lele Zhou
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P. R. China
| | - Ning Ma
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P. R. China
| | - Weiping Qian
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P. R. China
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14
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Yeomans J, Sastry A. pCONUS 2 and pCONUS 2-HPC for the treatment of wide-necked intracranial aneurysms: Periprocedural, 6-month, and early 2-year follow-up outcomes. Interv Neuroradiol 2021; 27:805-814. [PMID: 33887974 DOI: 10.1177/15910199211011887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE pCONUS 2 and pCONUS 2-HPC are novel neck-bridging devices designed to support endovascular coil occlusion of wide-necked intracranial bifurcation aneurysms. This study summarises periprocedural outcomes, 6-month, and early 2-year follow-up results following its introduction in an interventional neuroradiology centre. MATERIALS/METHODS This prospective, single-arm study assessed 20 aneurysms treated over a 40 month time period from time of procedure to 2 years post-procedure. Data collected included patient demographics, aneurysm features, and intraprocedural, 6-month, and 2-year post-procedural complications and angiographic features. RESULTS The mean age of the cohort was 59+-SD 7.7 years. 16 unruptured aneurysms were treated (pCONUS 2 13/16, pCONUS 2-HPC 3/16) and 4 ruptured aneurysms were treated with pCONUS 2-HPC. Unruptured cases received dual antiplatelet therapy pre- and post-procedure while ruptured cases received single antiplatelet therapy. 9/20 aneurysms were located at the MCA bifurcation and 7/20 at the basilar tip. The remaining 4 aneurysms were at various bifurcations in the anterior circulation. 11/20 were small (<10mm) and 9/20 were large (10-25mm). There was one periprocedural complication: a retroperitoneal bleed. There were no post-procedural intracranial complications or at 6-months follow-up. At 6 months, satisfactory occlusion was achieved in 94% of cases (15/16). There was one delayed death at 2-year follow-up from an unrelated cause. CONCLUSION pCONUS 2 and pCONUS 2-HPC have excellent short and medium-term safety profiles and clinical outcomes with no procedure-related mortality or morbidity and good occlusion rates at 6-month follow-up. The use of pCONUS 2-HPC with single antiplatelet therapy is feasible and did not cause any complications.
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Affiliation(s)
- J Yeomans
- University Hospital of Wales, Cardiff, UK
| | - A Sastry
- University Hospital of Wales, Cardiff, UK
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15
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Pearce S, Maingard JT, Kuan Kok H, Barras CD, Russell JH, Hirsch JA, Chandra RV, Jhamb A, Thijs V, Brooks M, Asadi H. Antiplatelet Drugs for Neurointerventions: Part 2 Clinical Applications. Clin Neuroradiol 2021; 31:545-558. [PMID: 33646319 DOI: 10.1007/s00062-021-00997-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
Endovascular techniques have expanded to include balloon and stent-assistance, flow diversion and individualized endovascular occlusion devices, to widen the treatment spectrum for more complex aneurysm morphologies. While usually well-tolerated by patients, endovascular treatment of intracranial aneurysms carries the risk of complications, with procedure-related ischemic complications being the most common. Several antiplatelet agents have been studied in a neurointerventional setting for both prophylaxis and in the setting of intraprocedural thrombotic complications. Knowledge of these antiplatelet agents, evidence for their use and common dosages is important for the practicing neurointerventionist to ensure the proper application of these agents.Part one of this two-part review focused on basic platelet physiology, pharmacology of common antiplatelet medications and future directions and therapies. Part two focuses on clinical applications and evidence based therapeutic regimens.
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Affiliation(s)
- Samuel Pearce
- Department of Radiology, Western Health, 160 Gordon St, 3011, Footscray, Victoria, Australia. .,Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia.
| | - Julian T Maingard
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Hong Kuan Kok
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia.,Interventional Radiology Service, Northern Health Radiology, Melbourne, Victoria, Australia
| | - Christen D Barras
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy H Russell
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia
| | - Joshua A Hirsch
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,Department of Imaging, Monash University, Melbourne, Victoria, Australia
| | - Ash Jhamb
- Interventional Neuroradiology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Mark Brooks
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Interventional Neuroradiology service, Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Interventional Neuroradiology service, Radiology Department, Austin Health, Melbourne, Victoria, Australia
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16
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Lobsien D, Clajus C, Behme D, Ernst M, Riedel CH, Abu-Fares O, Götz FG, Fiorella D, Klisch J. Aneurysm Treatment in Acute SAH with Hydrophilic-Coated Flow Diverters under Single-Antiplatelet Therapy: A 3-Center Experience. AJNR Am J Neuroradiol 2021; 42:508-515. [PMID: 33446495 DOI: 10.3174/ajnr.a6942] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE In certain clinical circumstances, dual-antiplatelet therapy can be problematic in patients with acute SAH. In some aneurysms, however, flow-diverting stents are the ideal therapeutic option. We report our experience with ruptured intracranial aneurysms treated with flow diverters with hydrophilic coating (p48 MW HPC and p64 MW HPC) under single-antiplatelet therapy. MATERIALS AND METHODS Patients were treated with either flow-diverter placement alone or a flow diverter and additional coiling. Due to the severity of the hemorrhage, the potential for periprocedural rehemorrhage, and the potential for additional surgical interventions, a single-antiplatelet regimen was used in all patients. RESULTS Thirteen aneurysms were treated in 10 patients. The median age was 62 years; 5 patients were male. All had acute SAH due to aneurysm rupture. Four blood-blister, 2 dissecting, and 7 berrylike aneurysms were treated. Seven aneurysms were adjunctively coiled. Eight of the 10 patients received a single-antiplatelet protocol of aspirin, 1 patient was treated with prasugrel only, and 1 patient was treated with tirofiban first and then switched to the aspirin single-antiplatelet protocol. One device-related complication occurred, a thrombosis of an overstented branch. All stents, however, remained open at DSA, CTA, or MRA follow-up. CONCLUSIONS The implantation of flow diverters with reduced thrombogenicity due to hydrophilic surface coating under single-antiplatelet therapy seems to be an option in carefully selected cases of SAH due to aneurysm rupture.
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Affiliation(s)
- D Lobsien
- From the Institute for Diagnostic and Interventional Neuroradiology (D.L., C.C., J.K.), Helios Klinikum Erfurt, Erfurt, Germany
| | - C Clajus
- From the Institute for Diagnostic and Interventional Neuroradiology (D.L., C.C., J.K.), Helios Klinikum Erfurt, Erfurt, Germany
| | - D Behme
- Institute for Diagnostic and Interventional Neuroradiology (D.B., M.E., C.H.R.), University Medical Center Göttingen, Göttingen, Germany
- Department for Neuroradiology (D.B.), University Hospital Magdeburg, Magedeburg, Germany
| | - M Ernst
- Institute for Diagnostic and Interventional Neuroradiology (D.B., M.E., C.H.R.), University Medical Center Göttingen, Göttingen, Germany
| | - C H Riedel
- Institute for Diagnostic and Interventional Neuroradiology (D.B., M.E., C.H.R.), University Medical Center Göttingen, Göttingen, Germany
| | - O Abu-Fares
- Institute for Diagnostic and Interventional Neuroradiology (O.A.-F., F.G.G.), Hanover Medical School, Hannover, Germany
| | - F G Götz
- Institute for Diagnostic and Interventional Neuroradiology (O.A.-F., F.G.G.), Hanover Medical School, Hannover, Germany
| | - D Fiorella
- Cerebrovascular Center (D.F.), Stony Brook Hospital, Stony Brook, New York
| | - J Klisch
- From the Institute for Diagnostic and Interventional Neuroradiology (D.L., C.C., J.K.), Helios Klinikum Erfurt, Erfurt, Germany
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17
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de Castro-Afonso LH, Nakiri GS, Abud TG, Monsignore LM, Freitas RK, de Oliveira RS, Colli BO, Dos Santos AC, Abud DG. Treatment of distal unruptured intracranial aneurysms using a surface-modified flow diverter under prasugrel monotherapy: a pilot safety trial. J Neurointerv Surg 2021; 13:647-651. [PMID: 33632882 DOI: 10.1136/neurintsurg-2020-017262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Flow diverters (FDs) are effective in the treatment of carotid aneurysms. Compared with carotid aneurysms, the treatment of distal intracranial aneurysms with FDs has been associated with a relatively high incidence of complications. Low thrombogenic modified-surface FDs may reduce ischemic complications and allow for the use of a single antiplatelet medication. The aim of this study was to assess the safety and efficacy of the p48 MW HPC Flow Modulation Device (Phenox GmbH, Bochum, Germany) to treat distal intracranial aneurysms used in combination with prasugrel monotherapy. METHODS This was a single-center, prospective, pivotal, open, single-arm study. Patients were included in this study from December 2019 to September 2020. The primary endpoints were the incidence of any neurologic deficit after treatment until 1 month of follow-up, defined as National Institutes of Health Stroke Scale (NIHSS) ≥1, and the incidence of acute ischemic lesions in magnetic resonance imagin (MRI) images 48 hours after treatment. The secondary endpoint was the rate of complete occlusion of the aneurysms at the 1-month follow-up. RESULTS Twenty-one patients harboring 27 distal aneurysms of the anterior circulation were included. Mean age was 57.8 (SD 9.7) years, and 16 patients were female (80%). No patient had neurologic symptoms at the 1-month follow-up. Four patients (20%) had asymptomatic acute brain ischemic lesions on MRI. Complete aneurysm occlusion occurred in 9/27 (33.3%) aneurysms at the 1-month follow-up. CONCLUSION In this pilot safety trial, treatment of distal intracranial aneurysms with p48 MW HPC under monotherapy with prasugrel appeared to be safe.
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Affiliation(s)
- Luis Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Thiago Giansante Abud
- Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.,Division of Interventional Neuroradiology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Rafael Kiyuze Freitas
- Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Antônio Carlos Dos Santos
- Division of Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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18
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de Castro-Afonso LH, Nakiri GS, Abud TG, Monsignore LM, de Freitas RK, Abud DG. Aspirin monotherapy in the treatment of distal intracranial aneurysms with a surface modified flow diverter: a pilot study. J Neurointerv Surg 2021; 13:336-341. [PMID: 33514613 DOI: 10.1136/neurintsurg-2020-017024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Flow diverters (FDs) result in high occlusion rates of aneurysms located distally to the carotid artery. However, the complications reported are not negligible. New modified surface FDs have low thrombogenic properties that may reduce ischemic complications related to the treatment. In addition, a modified surface FD may allow for the use of a single antiplatelet medication to reduce hemorrhagic risk during the procedure. The aim of this study was to assess the safety and efficacy of the p48 MW HPC (phenox, Bochum, Germany) to treat distal intracranial aneurysms under the use of aspirin monotherapy. METHODS The primary endpoint was the incidence of any neurologic deficit after treatment after 6 months of follow-up. The secondary endpoint was the rate of the complete occlusion of the aneurysms at the 6-month follow-up. Enrollment of 20 patients was planned, but after inclusion of seven patients the study was stopped due to safety issues. RESULTS Seven patients with eight aneurysms were included. Among the seven patients, three (42.8%) had ischemic complications on the second day after FD deployment. Two patients experienced complete recovery at discharge (National Institutes of Health Stroke Scale (NIHSS) score=0), while one patient maintained mild dysarthria at discharge (NIHSS score=1) which improved after 6 months (NIHSS score=0). All three patients had no new symptoms during the 6-month follow-up. Complete aneurysm occlusion occurred in six (75%) of the eight aneurysms at the 6-month follow-up. CONCLUSIONS Antiplatelet monotherapy with aspirin for the treatment of distal intracranial aneurysms with this modified surface FD resulted in a significant incidence of ischemic complications after treatment.
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Affiliation(s)
- Luis Henrique de Castro-Afonso
- 1Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil
| | - Guilherme Seizem Nakiri
- 1Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil
| | - Thiago Giansante Abud
- 1Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil.,Interventional Neuroradiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Lucas Moretti Monsignore
- 1Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil
| | - Rafael Kiyuze de Freitas
- 1Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil
| | - Daniel Giansante Abud
- 1Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil
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19
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Guzzardi G, Galbiati A, Stanca C, Del Sette B, Paladini A, Cossandi C, Carriero A. Flow diverter stents with hydrophilic polymer coating for the treatment of acutely ruptured aneurysms using single antiplatelet therapy: Preliminary experience. Interv Neuroradiol 2020; 26:525-531. [PMID: 32799747 PMCID: PMC7645186 DOI: 10.1177/1591019920950878] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The use of flow diverter stent (FDS) has limitations in cases of subarachnoid haemorrhage caused by ruptured aneurysm, due to the need for double antiplatelet therapy and the delay in the aneurysm occluding. The p48 MW and the p64 MW (Phenox) are available with Hydrophilic Polymer Coating (HPC), that reduces the risk of thrombus formation. Purpose of this study is to evaluate the safety and efficacy of p48 and p64 MW HPC with single antiplatelet therapy for the acute treatment of ruptured aneurysm. METHODS We retrospectively evaluated all patients treated for acutely ruptured aneurysms with a p48 MW HPC or p64 MW HPC from October 2019 to April 2020 using single antiplatelet therapy. For each patient, we considered demographic and aneurysm-related data, clinical presentation, size and location of the implanted flow diverter stent, intra- and post-procedural complications, aneurysm occlusion. RESULTS Seven patients were included. The ruptured aneurysms were four saccular, two blister-like and one dissecting, six in the anterior and one in posterior circulation. No intraprocedural stent thrombosis and rebleeding was observed. In two cases the aneurysm is completely excluded, in one patient it was found only neck perfusion, in three cases there were mild reduction of the sac and in one case there was a persistent perfusion. No patients needed retreatment in this series. CONCLUSION In our experience, FDS HPC appears a potential treatment option in selected cases. Our study is limited by small population and short-term follow-up. We report our preliminary data, but further investigations are necessary.
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Affiliation(s)
- Giuseppe Guzzardi
- Department of Interventional and Neurointerventional Radiology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Andrea Galbiati
- Department of Interventional and Neurointerventional Radiology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Carmelo Stanca
- Department of Interventional and Neurointerventional Radiology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Bruno Del Sette
- Department of Interventional and Neurointerventional Radiology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Andrea Paladini
- Department of Interventional and Neurointerventional Radiology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Christian Cossandi
- Division of Neurosurgery, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Alessandro Carriero
- Department of Interventional and Neurointerventional Radiology, University Hospital “Maggiore della Carità”, Novara, Italy
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20
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Schob S, Kläver M, Richter C, Scherlach C, Maybaum J, Mucha S, Schüngel MS, Hoffmann KT, Quaeschling U. Single-Center Experience With the Bare p48MW Low-Profile Flow Diverter and Its Hydrophilically Covered Version for Treatment of Bifurcation Aneurysms in Distal Segments of the Anterior and Posterior Circulation. Front Neurol 2020; 11:1050. [PMID: 33071937 PMCID: PMC7538783 DOI: 10.3389/fneur.2020.01050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/11/2020] [Indexed: 12/23/2022] Open
Abstract
Background and Purpose: Flow diversion has profoundly changed the way aneurysms are treated. However, it conventionally requires dual antiplatelet medication and has yet been considered off-label use in the posterior circulation or within peripheral vessels of the anterior circulation. Here, we report our experience with the p48MW/p48MW hydrophilic coating (HPC) in the anterior and posterior circulation. This novel low-profile flow diverter is specifically designed for treatment of small peripheral vessels, and the p48MW HPC has an anti-thrombotic polymer coating, which allows application of a single antiplatelet function medication in conditions that expectably require further surgery. Materials and Methods: Thirty-two patients were prospectively included. Twenty-six treatments were performed with one flow diverter, four required two overlapping flow diverters, one case demanded three overlapping flow diverters, and in one case, extensive dissecting aneurysm telescoping with eight flow diverters was necessary. Twenty-two complex bifurcation aneurysms were treated. Three months' follow-up was available for 14 patients. Results: Deployment was uneventful in all cases. In four cases, undersizing was unavoidable and resulted in significant shortening of the flow diverter, which demanded implantation of further flow diverters to sufficiently treat the target aneurysm. Three flow diverters required balloon angioplasty for optimal wall approximation. All parent vessels remained patent. Available 3-month follow-up studies showed decreased influx or delayed washout in all aneurysms; none was occluded completely. There were no device-related clinical complications. Conclusions: Implantation of the p48MW/p48MW HPC is safe and effective for treatment of distally located cerebral aneurysms. Considering the reported rates of ischemic complications associated with flow diversion of complex bifurcation aneurysms, the p48MW/p48MW HPC potentially provides increased safety for complex bifurcation aneurysms in the anterior and posterior circulation.
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Affiliation(s)
- Stefan Schob
- Abteilung für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Monika Kläver
- Abteilung für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Cindy Richter
- Abteilung für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Cordula Scherlach
- Abteilung für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Jens Maybaum
- Abteilung für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Simone Mucha
- Abteilung für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Karl Titus Hoffmann
- Abteilung für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulf Quaeschling
- Abteilung für Neuroradiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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21
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Aguilar Perez M, Hellstern V, Serna Candel C, Wendl C, Bäzner H, Gansladt O, Henkes H. Use of pCONUS HPC for the treatment of unruptured wide-necked bifurcation aneurysms: early clinical experience using single antiplatelet therapy. Stroke Vasc Neurol 2020; 6:57-64. [PMID: 32920538 PMCID: PMC8005901 DOI: 10.1136/svn-2020-000399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/13/2020] [Accepted: 07/30/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In recent years, a growing number of stents and stent-like devices have become available to facilitate the treatment of challenging aneurysms. However, the need for dual antiplatelet therapy can limit their use, especially in ruptured aneurysms. The hydrophilic polymer coating (pHPC, phenox) is a novel glycan-based multilayer polymer that reduces platelet adhesion. This study aims to report our initial experience using the pCONUS HPC device for the treatment of unruptured wide-necked bifurcation aneurysms (WNBA) using acetylsalicylic acid (ASA) as single antiplatelet therapy (SAPT). METHODS We retrospectively identified all patients who were treated with the pCONUS HPC for unruptured WNBA in a multi-staged procedure using ASA as SAPT. Records were made of periprocedural complications, clinical outcome and angiographic and clinical follow-up. RESULTS We identified 15 patients with 15 WNBA. The average age was 69 years old (range, 41-76). Seven aneurysms were located in the middle cerebral artery, five in the anterior communicating artery, two at the basilar tip and one in the posterior communicating artery. Immediate post-treatment angiography showed five aneurysms with modified Raymond-Roy classification (mRRC) grade I and four aneurysms with mRRC grade II. There were no haemorrhagic complications. Four patients developed thrombus formation during the second treatment session, all of them completely resolving after administration of glycoprotein IIb/IIIa antagonists. Angiographic follow-up data were available for 10 patients and showed adequate occlusion (mRRC I or II) in eight aneurysms (80%). In-stent stenosis was observed in one patient whereas two patients showed de novo stenosis in one of the efferent branches. CONCLUSIONS This early experience on the use of the pCONUS HPC device suggests that it can be useful for treating unruptured WNBA under ASA as SAPT. Further investigation with a randomised treatment registry and larger cohort is needed.
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Affiliation(s)
- Marta Aguilar Perez
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Victoria Hellstern
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Carmen Serna Candel
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Christina Wendl
- Institut für Röntgendiagnostik, Zentrum für Neuroradiologie, Fakultät für Medizin der Universität Regensburg, Regensburg, Germany
| | - Hansjörg Bäzner
- Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Oliver Gansladt
- Neurochirurgische, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.,Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany
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22
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Pranata R, Yonas E, Vania R, Sidipratomo P, July J. Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm-A systematic review and meta-analysis. Interv Neuroradiol 2020; 27:60-67. [PMID: 32635777 DOI: 10.1177/1591019920940521] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. METHOD We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. RESULTS There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%-94%) and 91% (95% CI, 85%-96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%-56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%-72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%-37%) of aneurysms immediately after coiling, and 25% (17-33) after six-month follow-up. Complications occur in 5% (95% CI, 1%-8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. CONCLUSIONS PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Prijo Sidipratomo
- Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Julius July
- Department of Neurosurgery, Medical Faculty, Pelita Harapan University, Tangerang, Indonesia.,Neuroscience Centre Siloam Hospital, Tangerang, Indonesia
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23
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Entezami P, Holden DN, Boulos AS, Paul AR, Field NC, Nourollahzadeh E, Yamamoto J, Dalfino JC. Cangrelor dose titration using platelet function testing during cerebrovascular stent placement. Interv Neuroradiol 2020; 27:88-98. [PMID: 32611215 DOI: 10.1177/1591019920936923] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Optimal antiplatelet inhibition is vital during cerebrovascular stenting procedures, yet no standardized recommendation exists for antithrombotic therapy in these scenarios. Cangrelor is an intravenous P2Y12 inhibitor with a favorable pharmacokinetic profile for use during neuroendovascular stenting. METHODS A retrospective review of all neuroendovascular patients who underwent stenting between 1 January 2019 and 22 March 2020 and were treated with cangrelor was conducted. Thirty-seven patients met inclusion criteria. RESULTS All patients were administered a bolus of 5 mcg/kg of cangrelor followed by a maintenance infusion. Antiplatelet effects of cangrelor were monitored using platelet reactivity units (PRU). Based on the initial PRU, seven patients' doses were adjusted with subsequent PRUs in or near the goal range of 50-150. One patient experienced an acute intraprocedural occlusion likely related to a subtherapeutic PRU which subsequently resolved with cangrelor dose adjustment and intra-arterial tirofiban administration, and one patient experienced a post-procedure stent occlusion which required a thrombectomy and intra-arterial tirofiban administration. No hemorrhagic complications occurred. DISCUSSION Cangrelor utilization during neuroendovascular stenting with maintenance doses of <2 mcg/kg/min with dose adjustments based on platelet function testing has not been previously described. Cangrelor presents many advantages compared to standard therapy in patients undergoing stent placement related to its pharmacokinetic profile, rapid onset of action, ease of transition to oral P2Y12 antiplatelet agents, and measurability. CONCLUSION Cangrelor is a promising alternative to currently available therapies, especially in patients with a high hemorrhagic risk.
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Affiliation(s)
- Pouya Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Devin N Holden
- Department of Pharmacy, Albany Medical Center, Albany, NY, USA
| | - Alan S Boulos
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Alexandra R Paul
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Nicholas C Field
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Emad Nourollahzadeh
- Department of Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Junichi Yamamoto
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - John C Dalfino
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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24
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Mühl-Benninghaus R. [Surface coatings to avoid dual antiplatelet therapy]. Radiologe 2020; 60:317-320. [PMID: 32152651 DOI: 10.1007/s00117-020-00670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The development of microstents for aneurysm treatment has greatly expanded endovascular aneurysm therapy. Due to the increased amount of foreign material, the use of such stents is associated with an increased risk of thrombus formation and therewith the associated risk of ischemic stroke. For this reason, various surface coatings have recently been developed. The primary aim of these coatings is to reduce the foreign matter-mediated platelet adhesion to the stent surfaces. The potential reduction of dual antiplatelet therapy when using coated stents was recently discussed. But currently, no neurointerventional guidelines or recommendations endorse the stent implantation under single antiplatelet therapy. This article describes the different coatings in the field of neurointervention and their mode of action.
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Affiliation(s)
- Ruben Mühl-Benninghaus
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66421, Kirrberger Straße, Deutschland.
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25
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Aguilar Perez M, AlMatter M, Hellstern V, Wendl C, Ganslandt O, Bäzner H, Henkes H. Use of the pCONus HPC as an adjunct to coil occlusion of acutely ruptured aneurysms: early clinical experience using single antiplatelet therapy. J Neurointerv Surg 2020; 12:862-868. [PMID: 32102920 PMCID: PMC7476363 DOI: 10.1136/neurintsurg-2019-015746] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/27/2022]
Abstract
Background Coil occlusion has become the standard treatment for many ruptured aneurysms. However, specific aneurysm structures pose technical difficulties and may require the use of adjunctive neck-bridging devices, which necessitate the use of dual antiplatelet therapy. The hydrophilic polymer coating (pHPC, phenox) is a surface modification that inhibits platelet adhesion. Objective To present initial experience with the pCONUS HPC device as an adjunct to coil embolization for ruptured aneurysms using single antiplatelet therapy (SAPT). Methods All patients who were treated with the pCONUS HPC for ruptured aneurysms using SAPT were retrospectively identified. The occurrence of thromboembolic and hemorrhagic complications was recorded together with the angiographic and clinical follow-up details. Results Fifteen patients were identified (nine female) with a median age of 54 years (range 27–81). Six aneurysms were located at the anterior communicating artery, five at the middle cerebral artery bifurcation, two at the basilar artery bifurcation, one at the posterior communicating artery, and one involving the intradural internal carotid artery. Ten patients (66.6%) achieved modified Raymond–Roy classification I or II at post-treatment angiography, with 45.5% of patients having adequate occlusion (defined as complete occlusion or neck remnant) at follow-up. All patients received acetylsalicylic acid (ASA) as SAPT before and after the procedure. Intraprocedural thrombus formation was seen in three patients (20%), resolving in two patients after a bolus dose of eptifibatide, and one treated with mechanical aspiration. No clinical or radiological consequences were seen. There were no recurrent aneurysm ruptures. One patient died owing to cerebral vasospasm. Conclusion This initial clinical experience highlights the possibility and limitations of using the pCONUS HPC device in the treatment of complex ruptured aneurysm with ASA as SAPT. Randomized trials with longer follow-up in larger cohorts are underway.
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Affiliation(s)
- Marta Aguilar Perez
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Muhammad AlMatter
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Victoria Hellstern
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Christina Wendl
- Institut für Röntgendiagnostik, Zentrum für Neuroradiologie, Universitatsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Oliver Ganslandt
- Neurochirurgische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Hansjörg Bäzner
- Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany.,Medizinische Fakultät der Universität Duisburg-Essen, Essen, Germany
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26
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Pop R, Harsan O, Martin I, Mihoc D, Richter JS, Manisor M, Simu M, Chibbaro S, Cebula H, Proust F, Beaujeux R. Balloon-assisted coiling of intracranial aneurysms using the Eclipse 2L double lumen balloon. Interv Neuroradiol 2020; 26:291-299. [PMID: 31930938 DOI: 10.1177/1591019919895676] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Eclipse 2L is a new double lumen balloon microcatheter for neurovascular use, with several design features that separate it from previous generation devices. We aimed to report our initial experience of balloon-assisted coiling of intracranial aneurysms using the Eclipse 2L balloon. MATERIALS AND METHODS Retrospective single-center review of patients who underwent balloon-assisted coiling with the Eclipse 2L balloon, for ruptured or unruptured intracranial aneurysms between 1 June 2016 and 31 December 2018. Cases with adjunctive use of stents and recurrences of previously embolized aneurysms were excluded. Patient files were used to extract aneurysm characteristics, complications, immediate and long-term results. RESULTS We identified 120 patients with 126 aneurysms, of which 83 (65.8%) unruptured. Average aneurysm size was 5.9 mm (standard deviation 3.2 mm), with a dome-to neck-ratio of 1.7 (SD 0.6). Most aneurysms (79.3%) were wide necked. Immediate angiographic exclusion (Raymond-Roy grade I-II) was obtained in 95.1% of cases (81.7% grade I and 13.4% grade II). Procedural morbidity was 3.2% with no procedural mortality. Follow-up imaging was available for 115 aneurysms (91.2%). After an average follow-up period of 8.9 months (SD 7.3 months), 96.5% of aneurysms presented class I-II occlusion. Two aneurysms (1.7%) were retreated during follow-up. CONCLUSION Balloon-assisted coiling using the Eclipse 2L double lumen balloon is feasible for aneurysms in a wide range of locations in the anterior and posterior circulation. The angiographic results and complication rates compare favorably with previously published studies.
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Affiliation(s)
- Raoul Pop
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.,Institut Hospitalo-Universitaire (iHU), Strasbourg, France
| | - Oana Harsan
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
| | - Ioan Martin
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
| | - Dan Mihoc
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
| | | | - Monica Manisor
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
| | - Mihaela Simu
- Neurology Department, Victor Babes University, Timisoara, Romania
| | - Salvatore Chibbaro
- Neurosurgery Department, Strasbourg University Hospitals, Strasbourg, France
| | - Helene Cebula
- Neurosurgery Department, Strasbourg University Hospitals, Strasbourg, France
| | - Francois Proust
- Neurosurgery Department, Strasbourg University Hospitals, Strasbourg, France
| | - Rémy Beaujeux
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.,Institut Hospitalo-Universitaire (iHU), Strasbourg, France
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