Comparison of intra-aneurysmal flow modification using optical flow imaging to evaluate the performance of Evolve and Pipeline flow diverting stents
Comparison of intra-aneurysmal flow modification using optical flow imaging to evaluate the performance of Evolve and Pipeline flow diverting stents
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DOI：
10.1136/neurintsurg-2019-015696
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发表时间：
2020-08-01
影响因子：
4.8
通讯作者：
Pereira, Vitor M.
中科院分区：
文献类型：
--
作者：
Cancelliere, Nicole Mariantonia;Nicholson, Patrick;Pereira, Vitor M.
背景血流分流支架(FDS)装置使大型复杂脑动脉瘤的治疗发生了革命性的变化，但仍有改进的空间，特别是在分流特性和与支架部署相关的技术挑战方面。在这项研究中，我们通过定量评估动脉瘤内的血流改变，比较了新一代Superpass Evolve(Stryker)和Pipeline Flex(Medtronic)装置的分流特性。方法采用体外实验装置，由4个颈内动脉瘤患者专用硅胶模型和脉动血流循环血流动力学模拟系统组成。Evolve和Pipeline支架以随机方式部署在每个动脉瘤模型的颈部，总共部署了8个设备。在放置每个FDS前和放置后分别进行60帧/S数字减影血管造影。采用光学流动分析方法，通过计算支架置入前后的平均血流幅度(MAFA)和比率，来测量支架对动脉瘤内血流的影响。结果支架置入前后的平均MAFA比值(n=4，平均值=0.62+/-0.09)显著低于管道支架(n=4，平均值=0.71+/-0.06)(p=0.03)。结论我们的体外实验结果表明，与管道支架相比，EVERVE支架具有更好的血流分流效果，这一临床证据表明，它可以促进患者更快的动脉瘤闭塞率。
Background Flow diverting stent (FDS) devices have revolutionized the treatment of large and complex brain aneurysms, but there is still room for improvement, particularly on the flow diversion properties and technical challenges associated with stent deployment. In this study we compared flow diversion properties between the new generation Surpass Evolve (Stryker) and the Pipeline Flex (Medtronic) devices by quantitatively evaluating intra-aneurysmal flow modification. Methods An in vitro experimental set-up was used, consisting of four patient-specific silicone models with internal carotid aneurysms and a circulating hemodynamic simulation system with pulsatile flow. The Evolve and Pipeline stents were deployed across the neck of each aneurysm model, in a randomized fashion, for a total of eight device deployments. A 60 frames/s digital subtraction angiography run was acquired before and after placement of each FDS. An optical flow-analysis method was used to measure intra-aneurysmal flow modification induced by the stent by calculating a mean aneurysm flow amplitude (MAFA) before and after stent placement and computing a ratio. Results Average MAFA ratio values calculated from pre- and post-stent placement were significantly lower after deployment of the Evolve (n=4, mean=0.62 +/- 0.09) compared with the Pipeline device (n=4, mean=0.71 +/- 0.06) (p=0.03). Conclusions Our in vitro results show that the Evolve stent had a superior flow diversion effect compared with the Pipeline stent, which-based on clinical evidence-suggest it may promote faster aneurysm occlusion rates in patients.