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Endovascular treatment with flow diverters may fail to occlude experimental bifurcation aneurysms

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

Animal models may explain how stents and flow diverters (FDs) may succeed or fail to treat bifurcation aneurysms.

Methods

In vitro studies were designed to anticipate device deformations in bifurcations. Large, wide-necked bifurcation aneurysms were constructed in 21 animals and treated 4–8 weeks later using stents and FDs in various combinations, forming four main groups: parent artery to right branch flow diversion (RBFD, n = 6), parent artery to left branch flow diversion (LBFD, n = 6), Y flow diversion (YFD, n = 4), and compared with high-porosity Y-stenting (YHPS, n = 4). The results include immediate and follow-up angiography at 3 months, followed by grading of the extent of neointimal coverage of devices at pathology.

Results

In vitro, all braided devices showed varying porosities according to characteristic zones. FDs can be compacted to decrease porosities, but a limiting factor is the constant presence of a more porous transition zone. In vivo, 3/6 RBFD, 4/6 LBFD, and 2/4 YFD treated aneurysms had decreased in size by 3 months, while those treated with YHPS increased in size (P = 0.15). There was a significant correlation between device porosities and extent of neointimal coverage (r = 0.639, P = 0.002), and between porosities and angiographic evolution (r = −0.655, P = 0.002), but not between neointima formation and angiographic evolution (r = −0.278, P = 0.235). Failures could be explained in all cases by the presence of leaks or holes in the neointima at the level of the transition zones.

Conclusion

FDs did not successfully treat most bifurcation aneurysms, at least in this animal model.

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Acknowledgments

This work was supported by a grant from the Heart and Stroke Foundation of Alberta to TED and by a grant from Le Fonds de Recherche du Québec - Santé (FRQS) to JR.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Notre-Dame Hospital, Centre Hospitalier de l’Université de Montréal, 1560 Sherbrooke East, Montreal, QC, H2L 4M1, Canada

    Jean Raymond

  2. Laboratory of Interventional Neuroradiology, CHUM Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Jean Raymond, Alina Makoyeva & Igor Salazkin

  3. Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, AB, Canada

    Tim E. Darsaut

  4. Service de Radiologie A, Centre Hospitalier Universitaire Strasbourg, Université Strasbourg 1, Hôpital Civil, Strasbourg, France

    Fabrice Bing

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  1. Jean Raymond
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Correspondence to Jean Raymond.

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Raymond, J., Darsaut, T.E., Makoyeva, A. et al. Endovascular treatment with flow diverters may fail to occlude experimental bifurcation aneurysms. Neuroradiology 55, 1355–1363 (2013). https://doi.org/10.1007/s00234-013-1272-4

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  • DOI: https://doi.org/10.1007/s00234-013-1272-4

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