Abstract
The self-expanding V-POD is a second-generation flow-diverting device with a low-porosity PTFE patch on a self-expanding microstent. The authors evaluated this device for the treatment of elastase-induced aneurysms in rabbits. Three V-POD types (A, circumferential patch closed-cell stent [n = 9]; B, asymmetric patch closed-cell stent [n = 7]; and C, asymmetric patch open-cell stent [n = 4]) were evaluated by using angiography, conebeam micro-CT, histology, and SEM. Aneurysm flow modifications were expressed in terms of immediate poststent/prestent ratios of maximum CA volume entering the aneurysm dome tracked on procedural angiograms. Flow modifications were correlated with 4 weeks' follow-up angiographic, micro-CT, histologic, and SEM results. Mechanical stent-deployment difficulties in 4 aneurysms (1 type A; 3 type B) led to suboptimal results and exclusion from analysis. Of the remaining 16 aneurysms, 4-week post-treatment angiograms showed no aneurysm filling in 10 (63%), 3 (∼19%) had no filling with a small remnant neck, and 3 (∼19%) had <0.25 filling. Successfully treated aneurysms (n = 16) demonstrated an immediate poststent/prestent CA maximum volume ratio of 0.13 ± 0.18% (0.0%-0.5%). Favorable contrast-flow modification on immediate angiography after deployment correlated significantly with aneurysm occlusion on follow-up angiography, micro-CT, and histology. The occlusion percentage derived from micro-CT was 96 ± 6.8%. Histology indicated advanced healing (grade ≥3) in the aneurysm dome in 13 of 16 cases. SEM revealed 15 of 16 stents in an advanced state of endothelialization. This study showed the feasibility and effectiveness of V-POD for aneurysm healing in a rabbit elastase model.
Highlights
AND PURPOSE: The self-expanding V-POD is a second-generation flow-diverting device with a low-porosity PTFE patch on a self-expanding microstent
This study showed the feasibility and effectiveness of V-POD for aneurysm healing in a rabbit elastase model
Ample evidence exists that IA development is due to altered hemodynamics at the parent vessel–aneurysm ostium.[1,2,3]
Summary
Three V-POD types (A, circumferential patch closed-cell stent [n ϭ 9]; B, asymmetric patch closed-cell stent [n ϭ 7]; and C, asymmetric patch open-cell stent [n ϭ 4]) were evaluated by using angiography, conebeam micro-CT, histology, and SEM. Types B and C required placement precision in the transversal and azimuthal directions; localization of the low-porosity patch can be achieved by using a set of 4 markers arranged in a quadrature.[13] Type A was designed for aneurysms without perforators in the immediate circumference of the aneurysm-bearing parent vessel; types B and C were designed for aneurysms with perforators in that same region. The devices were designed, by using AutoCAD software (Autodesk, http://usa.autodesk.com), to be similar to current commercially available intracranial self-expanding microstents. They were cut in a laser machine shop (Laserage, Waukegan, Illinois) by using nitinol tubing (Ni-Ti Tubes, http://www.ni-ti.com/about.shtml) with 100-m wall thickness. After the devices were machined, they were heat-shaped to a 4-mm expanded diameter and electropolished by using commercially available chemicals (RD-Chemical, http:// rdchem.com)
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