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Cayron AF, Morel S, Allémann E, Bijlenga P, Kwak BR. Imaging of intracranial aneurysms in animals: a systematic review of modalities. Neurosurg Rev 2023; 46:56. [PMID: 36786880 PMCID: PMC9928939 DOI: 10.1007/s10143-023-01953-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
Intracranial aneurysm (IA) animal models are paramount to study IA pathophysiology and to test new endovascular treatments. A number of in vivo imaging modalities are available to characterize IAs at different stages of development in these animal models. This review describes existing in vivo imaging techniques used so far to visualize IAs in animal models. We systematically searched for studies containing in vivo imaging of induced IAs in animal models in PubMed and SPIE Digital library databases between 1 January 1945 and 13 July 2022. A total of 170 studies were retrieved and reviewed in detail, and information on the IA animal model, the objective of the study, and the imaging modality used was collected. A variety of methods to surgically construct or endogenously induce IAs in animals were identified, and 88% of the reviewed studies used surgical methods. The large majority of IA imaging in animals was performed for 4 reasons: basic research for IA models, testing of new IA treatment modalities, research on IA in vivo imaging of IAs, and research on IA pathophysiology. Six different imaging techniques were identified: conventional catheter angiography, computed tomography angiography, magnetic resonance angiography, hemodynamic imaging, optical coherence tomography, and fluorescence imaging. This review presents and discusses the advantages and disadvantages of all in vivo IA imaging techniques used in animal models to help future IA studies finding the most appropriate IA imaging modality and animal model to answer their research question.
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Affiliation(s)
- Anne F Cayron
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Clinical Neurosciences - Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Department of Clinical Neurosciences - Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Brenda R Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland.
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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2
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Ku JC, Dobashi Y, Pasarikovski CR, Ramjist J, Hamani C, Heyn C, Walus K, Yang VXD. Photosensitive Hydrogel-Based Embolic Agent Treatment of Wide-Necked Aneurysms: Preliminary Animal Results. Gels 2022; 8:gels8120788. [PMID: 36547312 PMCID: PMC9778217 DOI: 10.3390/gels8120788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background: The endovascular treatment of cerebral aneurysms has become widespread but may still be limited by recurrence rates or complications. The discovery of novel embolic strategies may help mitigate these concerns. Methods: We formulated a Photosensitive Hydrogel Polymer (PHP) embolic agent which is low-viscosity, shear-thinning, and radio-opaque. After the filling of an aneurysm with PHP with balloon assistance, we utilized photopolymerization to induce solidification. Different methods of light delivery for photopolymerization were assessed in silicone models of aneurysms and in four acute animal trials with venous anastomosis aneurysms in pigs. Then, balloon-assisted embolization with PHP and photopolymerization was performed in three aneurysms in pigs with a one-month follow-up. Filling volume, recurrence rates, and complications were recorded. Results: The PHP was found to be suitable for the intravascular delivery and treatment of cerebral aneurysms. It was found that light delivery through the balloon catheter, as opposed to light delivery through the injection microcatheter, led to higher rates of filling in the 3D model and acute animal model for cerebral aneurysms. Using the balloon-assisted embolization and light delivery strategy, three wide-necked aneurysms were treated without complication. One-month follow-up showed no recurrence or neck remnants. Conclusions: We demonstrated a novel method of balloon-assisted photosensitive hydrogel polymer embolization and photopolymerization, leading to complete aneurysm filling with no recurrence at 1 month in three wide-necked aneurysms in pigs. This promising methodology will be investigated further with longer-term comparative animal trials.
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Affiliation(s)
- Jerry C. Ku
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence:
| | - Yuta Dobashi
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Joel Ramjist
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Clement Hamani
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Chinthaka Heyn
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Neuroradiology, Department of Radiology, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Konrad Walus
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Victor X. D. Yang
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
- Division of Neurosurgery, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, ON N6A 3K7, Canada
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3
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Huang W, Zeng Z, Lang Y, Xiang X, Qi G, Lu G, Yang X. Cannabis Seed Oil Alleviates Experimental Atherosclerosis by Ameliorating Vascular Inflammation in Apolipoprotein-E-Deficient Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:9102-9110. [PMID: 34037390 DOI: 10.1021/acs.jafc.0c07251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In recent decades, epidemiological, clinical, and experimental studies have demonstrated that a diet with antioxidant or anti-inflammatory function plays a central role in the prevention of atherosclerosis (AS). The purpose of this study was to explore the effects of Cannabis seed oil (CO) administration on in vitro antioxidant capacity as well as blood lipid profiles, lipid peroxidation, inflammatory response, and endothelial cell integrity. Female ApoE-/- mice were fed a high-cholesterol diet and administrated with CO or phosphate-buffered saline (PBS) and seal oil by gavage for 8 weeks. The results show that CO administration reduced the levels of serum triglycerides and low-density lipoprotein cholesterol at week 6. Additionally, a decrease in serum tumor necrosis factor α and nitric oxide was also observed. Moreover, results from CD31 staining and scanning electron microscopy revealed that CO treatment alleviated the endothelial cell damage and lipid deposition induced by a high-cholesterol diet. The ratio of lesion area to the total aorta area was 19.57% for the CO group, which was lower than the PBS control group (24.67%). Collectively, CO exerted anti-atherosclerotic effects by modulating serum lipid profiles and inflammatory responses and improving endothelial cell integrity and arterial lipid deposition. The results provide a promising preventive strategy for the early progression of AS.
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Affiliation(s)
- Wenjing Huang
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan, Hubei 430023, People's Republic of China
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074, People's Republic of China
| | - Zhujun Zeng
- College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei 430070, People's Republic of China
| | - Yan Lang
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074, People's Republic of China
| | - Xia Xiang
- Oil Crops Research Institute of the Chinese Academy of Agricultural Sciences, Wuhan, Hubei 430062, People's Republic of China
| | - Gaofu Qi
- College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei 430070, People's Republic of China
| | - Gan Lu
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074, People's Republic of China
| | - Xiangliang Yang
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074, People's Republic of China
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4
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Hu J, Albadawi H, Oklu R, Chong BW, Deipolyi AR, Sheth RA, Khademhosseini A. Advances in Biomaterials and Technologies for Vascular Embolization. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1901071. [PMID: 31168915 PMCID: PMC7014563 DOI: 10.1002/adma.201901071] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/24/2019] [Indexed: 05/03/2023]
Abstract
Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.
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Affiliation(s)
- Jingjie Hu
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Brian W Chong
- Departments of Radiology and Neurological Surgery, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Amy R. Deipolyi
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, 1275 York Avenue, New York, New York 10065, USA
| | - Rahul A. Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, USA
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Radiological Sciences, Department of Chemical and Biomolecular Engineering, Center for Minimally Invasive Therapeutics, California Nanosystems Institute, University of California, 410 Westwood Plaza, Los Angeles, California 90095, USA
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5
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Chopra AM, Cruz JP, Hu YC. Polymer Embolism from Bioactive and Hydrogel Coil Embolization Technology: Considerations for Product Development. AJNR Am J Neuroradiol 2019; 40:E34-E35. [PMID: 31122920 DOI: 10.3174/ajnr.a6083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A M Chopra
- Chemical Engineer/Medical Researcher Camarillo, California
| | - J P Cruz
- Department of Radiology Hospital Clínico de la Pontificia Universidad Católica de Chile Santiago, Chile
| | - Y C Hu
- Department of Neurosurgery University Hospitals Cleveland Medical Center Cleveland, Ohio
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6
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Fohlen A, Namur J, Ghegediban H, Laurent A, Wassef M, Pelage JP. Midterm Recanalization after Arterial Embolization Using Hydrogel-Coated Coils versus Fibered Coils in an Animal Model. J Vasc Interv Radiol 2018; 30:940-948. [PMID: 30174160 DOI: 10.1016/j.jvir.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare angiographic and pathologic effects (ie, occlusion, recanalization) after embolization with Hydrogel-coated coils (HydroCoils) and fibered coils in the renal and internal iliac arteries after 7 days and 1 and 4 months in an animal model. MATERIALS AND METHODS Twelve sheep had 1 internal iliac and 1 renal artery randomly embolized with HydroCoils or fibered coils. Renal and internal iliac arteries were embolized with detachable 0.018-inch coils and pushable 0.035-inch coils, respectively. All animals had control angiography performed at 7 days, and 1 and 4 months to assess recanalization before euthanasia. Recanalization and inflammation were evaluated via pathologic examination. RESULTS At 1 month, 100% of arteries embolized with HydroCoils were occluded vs 50% of those embolized with fibered coils (P = .004). At 4 months, 80% of arteries embolized with HydroCoils were occluded vs 25% of those embolized with fibered coils (P = .01). Surface of vessel occlusion was significantly greater for iliac arteries (96.7% ± 8.9) than for renal arteries (94.2% ± 5.3; P = .0076). Surface of occlusion of the renal arteries (92.2% ± 5.1) was lower for fibered coils than for HydroCoils (96.8% ± 4.7; P = .0287). Surface percentage of thrombus was significantly lower for HydroCoils than for fibered coils (P < .0001). Surface percentage of thrombus was correlated with surface percentage of recanalization (P = .0181). CONCLUSIONS After 4 months, 75% of arteries embolized with fibered coils were recanalized vs 20% of those embolized with HydroCoils (P = .01). Reduced amount of thrombus after embolization with HydroCoils accounted for a reduced rate of arterial recanalization.
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Affiliation(s)
- Audrey Fohlen
- UNICAEN, CEA, Centre National de la Recherche Scientifique, ISTCT-CERVOxy, Normandie University, 14000 Caen, France
| | | | | | - Alexandre Laurent
- Department of Neuroradiology, Hôpital Lariboisière, Université Paris, Paris, France
| | - Michel Wassef
- Department of Pathology, Hôpital Lariboisière, Université Paris, Paris, France
| | - Jean-Pierre Pelage
- UNICAEN, CEA, Centre National de la Recherche Scientifique, ISTCT-CERVOxy, Normandie University, 14000 Caen, France.
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7
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Abi-Aad KR, Aoun RJN, Rahme RJ, Ward JD, Kniss J, Kwasny MJ, Sattur MG, Welz ME, Bendok BR. New generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): a study protocol for a multicenter randomized controlled trial. Neuroradiology 2018; 60:1075-1084. [DOI: 10.1007/s00234-018-2074-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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8
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Usami Y, Hirokawa N, Saitoh M, Okuda H, Someya M, Hasegawa T, Takakuwa Y, Sakata KI. Histopathological differences of experimental aneurysms treated with bare platinum, fibered, and bioactive coils. MINIM INVASIV THER 2018; 28:172-177. [PMID: 30113870 DOI: 10.1080/13645706.2018.1499532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the histopathological features of experimental aneurysms embolized with bare platinum, fibered, and bioactive coils. MATERIAL AND METHODS Twelve experimental aneurysms were constructed in three swine. The aneurysms were divided into four groups and were embolized using a bare platinum coil alone (P group, n = 2), a bioactive coil alone (B group, n = 2), a combination of fibered and bare platinum coils (F/P group, n = 4) and a combination of fibered and bioactive coils (F/B group, n = 4). Histopathological data for all aneurysms recorded at 63 days were analyzed in terms of neointima formation, fibrosis, foreign-body giant-cell infiltration, and organization. RESULTS Fibrosis was significantly greater in group B compared with that in group F/P (p = .02). Inflammation with foreign-body giant-cell infiltration was significantly greater in groups F/P and F/B compared with that in groups P and B (p = .007). CONCLUSION The present study revealed that the embolic effect of fibered coils was not a thrombus but instead was a foreign-body response in the chronic phase.
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Affiliation(s)
- Yoko Usami
- a Department of Radiology , Sapporo Medical University , Sapporo , Japan
| | - Naoki Hirokawa
- a Department of Radiology , Sapporo Medical University , Sapporo , Japan
| | - Masato Saitoh
- a Department of Radiology , Sapporo Medical University , Sapporo , Japan
| | - Hiroki Okuda
- a Department of Radiology , Sapporo Medical University , Sapporo , Japan
| | - Masanori Someya
- a Department of Radiology , Sapporo Medical University , Sapporo , Japan
| | - Tadashi Hasegawa
- b Department of Surgical Pathology , Sapporo Medical University , Sapporo , Japan
| | - Yasunari Takakuwa
- c Department of Surgical Pathology , NTT-East Sapporo Hospital , Sapporo , Japan
| | - Koh-Ichi Sakata
- a Department of Radiology , Sapporo Medical University , Sapporo , Japan
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9
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Horn JD, Maitland DJ, Hartman J, Ortega JM. A computational thrombus formation model: application to an idealized two-dimensional aneurysm treated with bare metal coils. Biomech Model Mechanobiol 2018; 17:1821-1838. [DOI: 10.1007/s10237-018-1059-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 07/21/2018] [Indexed: 10/28/2022]
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10
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Peripheral Embolization Using Hydrogel-Coated Coils Versus Fibered Coils: Short-Term Results in an Animal Model. Cardiovasc Intervent Radiol 2017; 41:305-312. [PMID: 29094195 DOI: 10.1007/s00270-017-1834-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To angiographically compare the occlusive effects of hydrocoils and fibered coils in the renal and internal iliac arteries at 24 h and 7 days in the sheep model. To determine the occlusive mechanism by hydrocoils and fibered coils by pathological examination. MATERIALS AND METHODS Two types of peripheral hydrogel-coated and fibered coils similar in diameter and length were compared. The right and left renal arteries were embolized with 0.018-inch detachable hydrocoils or fibered coils in six sheep. Then, the right and left internal iliac arteries were embolized with 0.035-inch pushable hydrocoils or fibered coils. Arterial recanalization was evaluated at 24 h and at 7 days with angiography. At pathology, the surface percentage of thrombus and embolic material (platinum, Dacron fibers and hydrogel) and the presence of inflammation were assessed. RESULTS No difference was found between the coils for recanalization at 24 h or 7 days. For hydrocoils, the surface of occlusion corresponded to thrombus for 42% and coil for 58% including 42% of platinum and 16% of hydrogel, respectively. For fibered coils, the surface of occlusion was composed of thrombus for 69% and of platinum and fibers for 31%. The surface percentage occupied by thrombus was significantly lower for hydrocoils than for fibered coils (p = 0.0047). The surface percentage of embolic was also different between the two products (p = 0.049). No degradation of hydrogel was found at any time points. CONCLUSION The percentage of thrombus was significantly less with hydrocoils as compared to fibered coils, which may account for reduced long-term recanalization.
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Neki H, Kohyama S, Otsuka T, Yonezawa A, Ishihara S, Yamane F. Optimal first coil selection to avoid aneurysmal recanalization in endovascular intracranial aneurysmal coiling. J Neurointerv Surg 2017; 10:50-54. [PMID: 28130502 DOI: 10.1136/neurintsurg-2016-012877] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/11/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Aneurysmal recanalization is a problem with endovascular coiling and one of its risk factors is the low volume embolization ratio (VER). The first coil VER (1st VER) is believed to be critical for obtaining a high VER. The main objective of this study was to evaluate factors potentially useful for selecting the optimal 1st VER for endovascular coiling. METHODS 609 initial saccular aneurysmal treatments performed between January 2010 and December 2014 at our institution were included in this retrospective study. Attempted procedures, retreatment cases, intraoperative rupture cases, and stent-assisted coiling cases were excluded. Age, sex, aneurysm location, ruptured aneurysm, aneurysm shape, neck size, maximum aneurysm size, dome-to-neck ratio, aneurysm volume, procedure, immediate Raymond scale score, 1st VER, and VER between the recanalization groups and non-recanalization groups were compared. RESULTS The factors related to recanalization were ruptured aneurysms, neck width, maximum aneurysm size, aneurysm volume, procedure, 1st VER, and VER. The cut-off values for aneurysm recanalization were a 1st VER of 10.0% and a VER of 33.0%. The maximum average VER of normal size aneurysms was found in the groups with a 1st VER of 17.5-20.0%. CONCLUSIONS 1st VER was found to be a helpful index for estimating aneurysmal recanalization after coil embolization. The target 1st VER was 17.5-20.0% for obtaining a higher VER and avoiding recanalization.
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Affiliation(s)
- Hiroaki Neki
- Division of Endovascular Neurosurgery, Stroke Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shinya Kohyama
- Division of Endovascular Neurosurgery, Stroke Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Toshihiro Otsuka
- Division of Endovascular Neurosurgery, Stroke Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Azusa Yonezawa
- Division of Endovascular Neurosurgery, Stroke Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shoichiro Ishihara
- Division Neurosurgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Fumitaka Yamane
- Division of Endovascular Neurosurgery, Stroke Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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12
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Rouchaud A, Brinjikji W, Dai D, Ding YH, Gunderson T, Schroeder D, Spelle L, Kallmes DF, Kadirvel R. Autologous adipose-derived mesenchymal stem cells improve healing of coiled experimental saccular aneurysms: an angiographic and histopathological study. J Neurointerv Surg 2017; 10:60-65. [PMID: 28077523 DOI: 10.1136/neurintsurg-2016-012867] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE Long-term occlusion of coiled aneurysms frequently fails, probably because of poor intrasaccular healing and inadequate endothelialization across the aneurysm neck. The purpose of this study was to determine if attachment of autologous mesenchymal stem cells (MSCs) to platinum coils would improve the healing response in an elastase-induced aneurysm model in rabbits. MATERIALS AND METHODS With approval from the institutional animal care and use committee, aneurysms were created in rabbits and embolized with control platinum coils (Axium; Medtronic) (n=6) or coils seeded ex vivo with autologous adipose-tissue MSCs (n=7). Aneurysmal occlusion after embolization was evaluated at 1 month with angiography. Histological samples were analyzed by gross imaging and graded on the basis of neck and dome healing on H&E staining. Fibrosis was evaluated using a ratio of the total area presenting collagen. Endothelialization of the neck was quantitatively analyzed using CD31 immunohistochemistry. χ2 and Student's t-test were used to compare groups. RESULTS Healing score (11.5 vs 8.0, p=0.019), fibrosis ratio (10.3 vs 0.13, p=0.006) and endothelialization (902 262 μm2 vs 31 810 μm2, p=0.041) were significantly greater in the MSC group. The MSC group showed marked cellular proliferation and thrombus organization, with a continuous membrane bridging the neck of the aneurysm. Angiographic stable or progressive occlusion rate was significantly lower in the MSC group (0.00, 95% CI 0.00 to 0.41) compared with controls (0.67, 95% CI 0.22 to 0.96) (p=0.02). CONCLUSIONS Autologous MSCs attached to platinum coils significantly improve histological healing, as they result in improved neck endothelialization and collagen matrix formation within the aneurysm sac.
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Affiliation(s)
- Aymeric Rouchaud
- Applied Neuroradiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Department of Interventional Neuroradiology, NEURI Center, Le Kremlin-Bicetre, France
| | | | - Daying Dai
- Applied Neuroradiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Hong Ding
- Applied Neuroradiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina Gunderson
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - Dana Schroeder
- Applied Neuroradiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Laurent Spelle
- Department of Interventional Neuroradiology, NEURI Center, Le Kremlin-Bicetre, France
| | - David F Kallmes
- Applied Neuroradiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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13
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Brinjikji W, Ding YH, Kallmes DF, Kadirvel R. From bench to bedside: utility of the rabbit elastase aneurysm model in preclinical studies of intracranial aneurysm treatment. J Neurointerv Surg 2016; 8:521-5. [PMID: 25904642 PMCID: PMC4932861 DOI: 10.1136/neurintsurg-2015-011704] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/06/2015] [Indexed: 11/03/2022]
Abstract
Preclinical studies are important in helping practitioners and device developers improve techniques and tools for endovascular treatment of intracranial aneurysms. Thus an understanding of the major animal models used in such studies is important. The New Zealand rabbit elastase induced arterial aneurysm of the common carotid artery is one of the most commonly used models in testing the safety and efficacy of new endovascular devices. In this review we discuss: (1) the various techniques used to create the aneurysm, (2) complications of aneurysm creation, (3) natural history of the arterial aneurysm, (4) histopathologic and hemodynamic features of the aneurysm, (5) devices tested using this model, and (6) weaknesses of the model. We demonstrate how preclinical studies using this model are applied in the treatment of intracranial aneurysms in humans. The model has similar hemodynamic, morphological, and histologic characteristics to human aneurysms, and demonstrates similar healing responses to coiling as human aneurysms. Despite these strengths, however, the model does have many weaknesses, including the fact that the model does not emulate the complex inflammatory processes affecting growing and ruptured aneurysms. Furthermore, the extracranial location of the model affects its ability to be used in preclinical safety assessments of new devices. We conclude that the rabbit elastase model has characteristics that make it a simple and effective model for preclinical studies on the endovascular treatment of intracranial aneurysms, but further work is needed to develop aneurysm models that simulate the histopathologic and morphologic characteristics of growing and ruptured aneurysms.
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Affiliation(s)
| | - Yong H Ding
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Gao Y, Lu Z, Chen C, Cui X, Liu Y, Zheng T, Jiang X, Zeng C, Quan D, Wang Q. Mesenchymal stem cells and endothelial progenitor cells accelerate intra-aneurysmal tissue organization after treatment with SDF-1α-coated coils. Neurol Res 2016; 38:333-41. [PMID: 27125512 DOI: 10.1080/01616412.2016.1164433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recurrences of aneurysms remain the major drawback of detachable coils for the endovascular treatment of intracranial aneurysms. The aim of the present study is to develop new modified coils, coating the surface of platinum coils with silk fibroin (SF) consisting of stromal cell-derived factor-1α (SDF-1α), and evaluate its acceleration of organization of cavities and reduction of lumen size in a rat aneurysm model. The morphological characteristics of SDF-1α-coated coils were examined using scanning electron microscopy (SEM). Fifty experimental aneurysms were created and randomly divided into five groups: three groups were embolized with SDF-1α-coated coils (8 mm) and two of these groups need transplantation of mesenchymal stem cells (MSCs) or endothelial progenitor cells (EPCs); one group was embolized with bare coils (8 mm) and another group severed as control. After coil implantation for 14 or 28 days, the coils were harvested and histological analysis was performed. SEM photographs showed that SF/SDF-1α-coated coils have uniform size and a thin film compared with bare coils. In the group treated with SDF-1α-coated coils, tissue organization was accelerated and the proliferation of α-smooth muscle actin positive cells was promoted in the aneurysmal sac. Compared with unmodified coils, on day 28, tissue organization was significantly greater in the group treated with SDF-1α-coated coils and MSC or EPC transplantation. These results suggest that SDF-1α-coated coils with MSC or EPC transplantation may be beneficial in the aneurysm healing and endothelialization at the orifice of embolized aneurysm.
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Affiliation(s)
- Yuyuan Gao
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China.,b Graduate School of Southern Medical University , Guangzhou , China.,c Department of Neurology , Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute , Guangzhou , China
| | - Ziming Lu
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China.,b Graduate School of Southern Medical University , Guangzhou , China
| | - Chengwei Chen
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China.,b Graduate School of Southern Medical University , Guangzhou , China
| | - Xubo Cui
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China.,b Graduate School of Southern Medical University , Guangzhou , China
| | - Yaqi Liu
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China.,b Graduate School of Southern Medical University , Guangzhou , China
| | - Tao Zheng
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China.,b Graduate School of Southern Medical University , Guangzhou , China
| | - Xiaodan Jiang
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Chi Zeng
- d School of Chemistry and Chemical Engineering , Sun Yat-Sen University , Guangzhou , China
| | - Daping Quan
- d School of Chemistry and Chemical Engineering , Sun Yat-Sen University , Guangzhou , China
| | - Qiujing Wang
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
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15
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Ishida W, Sato M, Amano T, Matsumaru Y. The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil. J Neurosurg 2016; 125:705-12. [PMID: 26745474 DOI: 10.3171/2015.7.jns15238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The importance of a framing coil (FC)-the first coil inserted into an aneurysm during endovascular coiling, also called a lead coil or a first coil-is recognized, but its impact on long-term outcomes, including recanalization and retreatment, is not well established. The purposes of this study were to test the hypothesis that the FC is a significant factor for aneurysmal recurrence and to provide some insights on appropriate FC selection. METHODS The authors retrospectively reviewed endovascular coiling for 280 unruptured intracranial aneurysms and gathered data on age, sex, aneurysm location, aneurysm morphology, maximal size, neck width, adjunctive techniques, recanalization, retreatment, follow-up periods, total volume packing density (VPD), volume packing density of the FC, and framing coil percentage (FCP; the percentage of FC volume in total coil volume) to clarify the associated factors for aneurysmal recurrence. RESULTS Of 236 aneurysms included in this study, 33 (14.0%) had recanalization, and 18 (7.6%) needed retreatment during a mean follow-up period of 37.7 ± 16.1 months. In multivariate analysis, aneurysm size (odds ratio [OR] = 1.29, p < 0.001), FCP < 32% (OR 3.54, p = 0.009), and VPD < 25% (OR 2.96, p = 0.015) were significantly associated with recanalization, while aneurysm size (OR 1.25, p < 0.001) and FCP < 32% (OR 6.91, p = 0.017) were significant predictors of retreatment. VPD as a continuous value or VPD with any cutoff value could not predict retreatment with statistical significance in multivariate analysis. CONCLUSIONS FCP, which is equal to the FC volume as a percentage of the total coil volume and is unaffected by the morphology of the aneurysm or the measurement error in aneurysm length, width, or height, is a novel predictor of recanalization and retreatment and is more significantly predictive of retreatment than VPD. To select FCs large enough to meet the condition of FCP ≥ 32% is a potential relevant factor for better long-term outcomes. These findings support our hypothesis that the FC is a significant factor for aneurysmal recurrence.
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Affiliation(s)
- Wataru Ishida
- Department of Neuro-endovascular Therapy, Toranomon Hospital, Tokyo, Japan; and.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Masayuki Sato
- Department of Neuro-endovascular Therapy, Toranomon Hospital, Tokyo, Japan; and
| | - Tatsuo Amano
- Department of Neuro-endovascular Therapy, Toranomon Hospital, Tokyo, Japan; and
| | - Yuji Matsumaru
- Department of Neuro-endovascular Therapy, Toranomon Hospital, Tokyo, Japan; and
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16
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Abstract
Hydrogel-coated coils are truly detachable coils with a platinum core covered with hydrogel. The coils are available in 0.018- and 0.035-in systems. These coils have the ability to expand up to four times their size ∼20 minutes after deployment, thus providing a very effective mechanical vascular occlusion effect. The vessel-occlusive effect of these coils is a volume, space-occupying effect, not a thrombotic effect, as seen in fibered coils. Hydrogel-coated coils were originally developed and designed to treat brain aneurysms; however, their use has expanded to peripheral applications. Hydrogel-coated coils have been used in the management of visceral aneurysms, high-flow vascular arteriovenous fistulae, and endoleaks after endovascular thoracic and abdominal aneurysm repair. The purpose of this article is to describe the hydrogel-coated coil system, the mechanism of action, technical details for optimal deployment, and clinical applications.
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Affiliation(s)
- Hector Ferral
- Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSystem, Evanston, Illinois
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17
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Dai D, Ding YH, Rezek I, Kallmes DF, Kadirvel R. Characterizing patterns of endothelialization following coil embolization: a whole-mount, dual immunostaining approach. J Neurointerv Surg 2015; 8:402-6. [PMID: 25646129 DOI: 10.1136/neurintsurg-2014-011513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/13/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND The extent, rate, and source of endothelialization following coil embolization of saccular aneurysms remains poorly understood. We performed a whole tissue mount, dual immunohistochemical analysis of experimental aneurysms to characterize the state of endothelialization over time after platinum coil embolization. METHOD AND MATERIAL Elastase-induced rabbit aneurysms were created and treated with bare platinum coils. Samples were harvested at 4 and 8 weeks (n=6 for each). En face whole tissue mount staining with antibodies to CD31 and α-smooth muscle actin was used to identify endothelial cells and smooth muscle cells, respectively. Sytox green stain was used to demonstrate nuclear morphology for identification of inflammatory cells. The extent of endothelialization was measured in relation to the aneurysm neck-parent artery interface. RESULTS At 4 weeks after coil embolization, very localized membranous tissue and neoendothelial cells were detected on the coil loops immediately adjacent to the parent artery-neck interface, but the remainder of the coil loops remained devoid of endothelial cells. At 8 weeks neoendothelial cells were more confluent over the coils than at 4 weeks, and extended up to 900 µm from the parent artery-neck interface. However, the surfaces of the coils farther away than this region harbored no endothelial cells. Scattered inflammatory cells, including neutrophils and monocytes, were seen on the coil surface at the neck central area, where the coil surface was bare at the 4 and 8 weeks' follow-up. CONCLUSIONS Platinum coil embolization supports gradual but limited endothelialization, where endothelial cells migrate directly from the adjacent parent artery.
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Affiliation(s)
- Daying Dai
- Neuroradiology Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Hong Ding
- Neuroradiology Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Issa Rezek
- Neuroradiology Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Neuroradiology Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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18
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Darki A, Goswami NJ, Mishkel GJ. Endovascular management of splenic artery aneurysms: case series using telescoping guide and cage/coil technique. Catheter Cardiovasc Interv 2014; 84:E65-70. [PMID: 24155131 DOI: 10.1002/ccd.25268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/07/2022]
Abstract
Splenic artery aneurysms are rare, but still the third most common abdominal aneurysm. Rupture is associated with significant morbidity and mortality. Traditionally, cardiologists have rarely been involved in the management of this entity. We present a series of four patients managed percutaneously by interventional cardiology using a combined telescoping guide and cage/coil technique.
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Affiliation(s)
- Amir Darki
- Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
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19
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Wang Q, Gao Y, Sun X, Ji B, Cui X, Liu Y, Zheng T, Chen C, Jiang X, Zhu A, Quan D. Acceleration of aneurysm healing by P(DLLA-co-TMC)-coated coils enabling the controlled release of vascular endothelial growth factor. Biomed Mater 2014; 9:045004. [PMID: 24945939 DOI: 10.1088/1748-6041/9/4/045004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since the introduction of the detachable coil in endovascular treatment of intracranial aneurysms, the in-hospital mortality rate has been significantly decreased. Recurrence of the aneurysm remains the major drawback of using detachable coils. We prepared a bioactive coil coated with poly(d,l-lactide)-7co-(1,3-trimethylene carbonate) (P(DLLA-co-TMC)), a novel copolymer for controlling the release of vascular endothelial growth factor (VEGF). Platinum coils were prepared by successive coating with cationic P(DLLA-co-TMC) and anionic heparin. Then, recombinant human VEGF-165 (rhVEGF) was immobilized by affinity binding to heparin. The morphological characteristics and sustained in vitro release of rhVEGF were examined using scanning electron microscopy and enzyme-linked immunosorbent assay, respectively. The efficacy of these novel coils modified by P(DLLA-co-TMC)/rhVEGF was tested using a common carotid artery aneurysm model in rats. Experimental aneurysms were embolized with unmodified, P(DLLA-co-TMC)/heparin-coated or P(DLLA-co-TMC)/rhVEGF-coated platinum coils (n = 18). The coils were removed on days 15, 30 and 90 after insertion, and the histological and immunohistochemical analysis of factor VIII was performed to confirm the presence of endothelial cells in the organized area. In addition, the controlled in vivo release of VEGF was confirmed by Western blotting analysis. The release of VEGF tended to increase during the whole period and no burst release was observed. In the group treated with P(DLLA-co-TMC)/rhVEGF-coated platinum coils, clot organization and endothelial cell proliferation were accelerated. The immunohistochemistry study showed that the expression of factor VIII was found in the P(DLLA-co-TMC)/rhVEGF-coated coil group but not in the other two groups. Furthermore, Western blotting analysis confirmed that the major released VEGF in the aneurysm sac was from the P(DLLA-co-TMC)/VEGF-coated coil. P(DLLA-co-TMC)/rhVEGF-coated platinum coils can promote clot organization and endothelial cell proliferation in a rat aneurysm model.
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Affiliation(s)
- Qiujing Wang
- Department of Neurosurgery, Zhujiang Hospital, The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Southern Medical University, Guangzhou 510282, Guangdong Province, People's Republic of China
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20
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Hudson JS, Hoyne DS, Hasan DM. Inflammation and human cerebral aneurysms: current and future treatment prospects. FUTURE NEUROLOGY 2013; 8. [PMID: 24376373 DOI: 10.2217/fnl.13.40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The formation of cerebral aneurysms and their rupture propensity is of immediate clinical importance. Current management includes observation with expectant management, microsurgical clipping and/or endovascular coiling. The surgical options are invasive and are not without increased risk despite the technological advances. Recent human and animal studies have shown that inflammation plays a critical role in aneurysm formation and progression to rupture. Modulating this inflammatory process may prove to be clinically significant. This review will discuss cerebral aneurysm pathogenesis with a focus on current and future research of potential use of pharmaceutical agents that attenuate inflammation in the aneurysm wall leading to decreased risk of aneurysm rupture.
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Affiliation(s)
| | - Danielle S Hoyne
- Department of Otolaryngology University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - David M Hasan
- Department of Neurosurgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52240, USA
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21
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De Vries J, Boogaarts J, Van Norden A, Wakhloo AK. New Generation of Flow Diverter (Surpass) for Unruptured Intracranial Aneurysms. Stroke 2013; 44:1567-77. [PMID: 23686973 DOI: 10.1161/strokeaha.111.000434] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In patients harboring intracranial aneurysms, the major goal in treatment is to prevent bleeding. A new generation of an endoluminal device (Surpass Flow Diverter [Surpass]) was developed to reconstruct parent artery and occlude the aneurysm. We present our clinical and angiographic single-center experience.
Methods—
Patients with a wide range of complex unruptured aneurysms were treated with the Surpass placed in the parent artery and bridging the aneurysm. Clinical and angiographic follow-up were performed at 6 months. Data were prospectively collected.
Results—
Thirty seven patients (mean age, 56 years; range, 32–79), harboring 49 unruptured aneurysms were treated at our center. All except 1 patient were treated with a single device. Successful delivery of the device was achieved in all patients. All 35 nonbifurcation aneurysm necks were covered completely, whereas 14 bifurcation aneurysms were only partially covered. There was no major periprocedural morbidity or mortality. During follow-up, 4 patients (10.4%) experienced transient neurological deficit. One patient (3%) developed a minor stroke at 4-month follow-up with persistent neurological deficit. Twelve patients had neurological symptoms related to their aneurysm and 7 showed improvement of these symptoms during follow-up. At 6-month follow-up, 29 of 31 aneurysms studied that had complete neck coverage showed a complete occlusion (94%) including 1 case with a 95% to 100% occlusion, whereas 5 of the 10 bifurcation aneurysms were occluded.
Conclusions—
Our study shows high safety and efficacy profile of a new generation endoluminal device in treatment of complex intracranial aneurysms. Long-term studies of treated bifurcation aneurysms are needed.
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Affiliation(s)
- Joost De Vries
- From the Departments of Neurosurgery (J.D.V., J.B.) and Neurology (A.V.N.), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; and Department of Radiology (A.K.W.), University of Massachusetts Medical School, Worcester, MA
| | - Jeroen Boogaarts
- From the Departments of Neurosurgery (J.D.V., J.B.) and Neurology (A.V.N.), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; and Department of Radiology (A.K.W.), University of Massachusetts Medical School, Worcester, MA
| | - Anouk Van Norden
- From the Departments of Neurosurgery (J.D.V., J.B.) and Neurology (A.V.N.), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; and Department of Radiology (A.K.W.), University of Massachusetts Medical School, Worcester, MA
| | - Ajay K. Wakhloo
- From the Departments of Neurosurgery (J.D.V., J.B.) and Neurology (A.V.N.), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; and Department of Radiology (A.K.W.), University of Massachusetts Medical School, Worcester, MA
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22
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Brennecka CR, Preul MC, Becker TA, Vernon BL. In vivo embolization of lateral wall aneurysms in canines using the liquid-to-solid gelling PPODA-QT polymer system: 6-month pilot study. J Neurosurg 2013; 119:228-38. [PMID: 23560578 DOI: 10.3171/2013.3.jns121865] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Over the past 20 years, endovascular embolization has become the preferred method of treating cerebral aneurysms. While there are many embolic devices on the market, none is ideal. In this study the authors investigated the use of a liquid-to-solid gelling polymer system-that is, poly(propylene glycol) diacrylate and pentaerythritol tetrakis (3-mercaptopropionate) (PPODA-QT)-to embolize in vivo aneurysms over a 6-month period. METHODS Experimental aneurysms were created in the carotid arteries of 9 canines. Aneurysms were embolized with the polymer only (PPODA-QT, 3 dogs), filled with PPODA-QT after placement of a "framing" platinum coil (coil+PPODA-QT, 3 dogs), or packed with platinum coils (coils only, 3 dogs). Aneurysm occlusion was angiographically monitored immediately and 6 months after embolization. After 6 months, the ostial regions of explanted aneurysms were assessed macroscopically and histologically. RESULTS All aneurysms showed 100% angiographic occlusion at 6 months, but turbulent blood flow was observed in 1 coils-only sample. Ostial regions of explanted coils-only aneurysms showed neointimal tissue surrounding individual coils but no continuous tissue layer over the aneurysm neck. All PPODA-QT aneurysms displayed smooth ostial surfaces, but 2 of 3 coil+PPODA-QT aneurysms showed polymer (unassociated with the coil) protruding into the vessel lumen, contributing to rough ostial surfaces. Neointimal tissue was present in PPODA-QT and coil+PPODA-QT aneurysms and covered smooth ostial surfaces more completely than in coils-only aneurysms. CONCLUSIONS This study compared neointimal tissue overgrowth in the ostium of experimental aneurysms embolized with PPODA-QT, PPODA-QT plus a framing coil, or coils alone. The coils-only and coil+PPODA-QT groups showed rough and discontinuous ostial surfaces, which hindered neointimal tissue coverage. The PPODA-QT aneurysms consistently produced smooth ostial surfaces that facilitated more complete neointimal tissue coverage over aneurysm necks.
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Affiliation(s)
- Celeste R Brennecka
- Center for Interventional Biomaterials, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287-9709, USA
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