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Griebel AJ, Maier P, Summers H, Clausius B, Kanasty I, He W, Peterson N, Czerniak C, Oliver AA, Kallmes DF, Kadirvel R, Schaffer JE, Guillory RJ. Radiopaque FeMnN-Mo composite drawn filled tubing wires for braided absorbable neurovascular devices. Bioact Mater 2024; 40:74-87. [PMID: 38962657 PMCID: PMC11220465 DOI: 10.1016/j.bioactmat.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/02/2024] [Accepted: 06/01/2024] [Indexed: 07/05/2024] Open
Abstract
Flow diverter devices are small stents used to divert blood flow away from aneurysms in the brain, stagnating flow and inducing intra-aneurysmal thrombosis which in time will prevent aneurysm rupture. Current devices are formed from thin (∼25 μm) wires which will remain in place long after the aneurysm has been mitigated. As their continued presence could lead to secondary complications, an absorbable flow diverter which dissolves into the body after aneurysm occlusion is desirable. The absorbable metals investigated to date struggle to achieve the necessary combination of strength, elasticity, corrosion rate, fragmentation resistance, radiopacity, and biocompatibility. This work proposes and investigates a new composite wire concept combining absorbable iron alloy (FeMnN) shells with one or more pure molybdenum (Mo) cores. Various wire configurations are produced and drawn to 25-250 μm wires. Tensile testing revealed high and tunable mechanical properties on par with existing flow diverter materials. In vitro degradation testing of 100 μm wire in DMEM to 7 days indicated progressive corrosion and cracking of the FeMnN shell but not of the Mo, confirming the cathodic protection of the Mo by the FeMnN and thus mitigation of premature fragmentation risk. In vivo implantation and subsequent μCT of the same wires in mouse aortas to 6 months showed meaningful corrosion had begun in the FeMnN shell but not yet in the Mo filament cores. In total, these results indicate that these composites may offer an ideal combination of properties for absorbable flow diverters.
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Affiliation(s)
| | - Petra Maier
- School of Mechanical Engineering, Stralsund University of Applied Sciences, Stralsund, DE, USA
| | - Henry Summers
- Department of Materials Science and Engineering, Michigan Technological University, USA
| | - Benjamin Clausius
- School of Mechanical Engineering, Stralsund University of Applied Sciences, Stralsund, DE, USA
| | - Isabella Kanasty
- Department of Biomedical Engineering, Michigan Technological University, USA
| | - Weilue He
- Department of Biomedical Engineering, Michigan Technological University, USA
| | - Nicholas Peterson
- Department of Biological Sciences, Michigan Technological University, USA
| | - Carolyn Czerniak
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, USA
| | | | | | | | | | - Roger J. Guillory
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, USA
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Ramirez-Velandia F, Mensah E, Salih M, Wadhwa A, Young M, Muram S, Taussky P, Ogilvy CS. Endothelial Progenitor Cells: A Review of Molecular Mechanisms in the Pathogenesis and Endovascular Treatment of Intracranial Aneurysms. Neuromolecular Med 2024; 26:25. [PMID: 38886284 DOI: 10.1007/s12017-024-08791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
This comprehensive review explores the multifaceted role of endothelial progenitor cells (EPCs) in vascular diseases, focusing on their involvement in the pathogenesis and their contributions to enhancing the efficacy of endovascular treatments for intracranial aneurysms (IAs). Initially discovered as CD34+ bone marrow-derived cells implicated in angiogenesis, EPCs have been linked to vascular repair, vasculogenesis, and angiogenic microenvironments. The origin and differentiation of EPCs have been subject to debate, challenging the conventional notion of bone marrow origin. Quantification methods, including CD34+ , CD133+ , and various assays, reveal the influence of factors, like age, gender, and comorbidities on EPC levels. Cellular mechanisms highlight the interplay between bone marrow and angiogenic microenvironments, involving growth factors, matrix metalloproteinases, and signaling pathways, such as phosphatidylinositol-3-kinase (PI3K) and mitogen-activated protein kinase (MAPK). In the context of the pathogenesis of IAs, EPCs play a role in maintaining vascular integrity by replacing injured and dysfunctional endothelial cells. Recent research has also suggested the therapeutic potential of EPCs after coil embolization and flow diversion, and this has led the development of device surface modifications aimed to enhance endothelialization. The comprehensive insights underscore the importance of further research on EPCs as both therapeutic targets and biomarkers in IAs.
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Affiliation(s)
- Felipe Ramirez-Velandia
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Emmanuel Mensah
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Aryan Wadhwa
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
| | - Michael Young
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Sandeep Muram
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Philipp Taussky
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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Hossan MR, Barot V, Harriet S, Peters L, Matsayko AC, Bauer A, Hossain K. Engineering Analysis of Non-Braided Polycaprolactone Bioresorbable Flow Diverters for Aneurysms. J Biomech Eng 2023; 145:111006. [PMID: 37470476 PMCID: PMC10578075 DOI: 10.1115/1.4063001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
This paper reports a nonbraided, bioresorbable polycaprolactone (PCL) flow diverter (FD) for the endovascular treatment of aneurysms. Bioresorbable FDs can reduce the risk associated with the permanent metallic FDs as they are resorbed by the body after curing of aneurysms. PCL FDs were designed and fabricated using an in-house hybrid electromelt spinning-fused deposition fabrication unit. Flow diverter's properties, surface qualities, and mechanical characteristics of PCL FDs of 50%, 60%, and 70% porosities were studied using scanning electron microscope (SEM), atomic force microscopy (AFM), and high precision universal testing machine (UTM). The deployability through a clinically relevant catheter was demonstrated in a PDMS aneurysm model. The angiographic visibility of the developed PCL FDs was evaluated using BaSO4 and Bi2O3 coatings of various concentration. The average strut thicknesses were 74.12 ± 6.63 μm, 63.07 ± 1.26 μm, and 56.82 ± 2.09 μm for PCL FDs with 50%, 60%, and 70% porosities, respectively. They average pore areas for the 50%, 60% and 70% porosities FDs were 0.055 ± 0.0056 mm2, 0. 0605 ± 0.0065 mm2, and 0.0712 ± 0.012 mm2, respectively. The surface quality was great with an RMS roughness value of 14.45 nm. The tensile, radial strength, and flexibility were found to be satisfactory and comparable to the nonbraided coronary stents. The developed PCL FDs were highly flexible and demonstrated to be deployable through conventional delivery system as low as 4 Fr catheters in a PDMS aneurysm model. The visibility under X-ray increases with the increasing concentration of coating materials BaSO4 and Bi2O3. The visibility intensity was slightly higher with Bi2O3 coating of PCL FDs. The overall results of the engineering analysis of the developed nonbraided PCL FDs are promising.
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Affiliation(s)
- Mohammad Robiul Hossan
- School of Engineering, Center for Interdisciplinary Biomedical Education and Research (CIBER), University of Central Oklahoma, Edmond, OK 73034
| | - Vishal Barot
- School of Engineering, University of Central Oklahoma, Edmond, OK 73034
| | - Seth Harriet
- School of Engineering, University of Central Oklahoma, Edmond, OK 73034
| | - Lauren Peters
- School of Engineering, University of Central Oklahoma, Edmond, OK 73034
| | | | - Andrew Bauer
- Department of Neurosurgery, University of Oklahoma - Health Science Center, Oklahoma City, OK 73104
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Oliver AA, Carlson KD, Bilgin C, Arturo Larco JL, Kadirvel R, Guillory RJ, Dragomir Daescu D, Kallmes DF. Bioresorbable flow diverters for the treatment of intracranial aneurysms: review of current literature and future directions. J Neurointerv Surg 2023; 15:178-182. [PMID: 35636949 PMCID: PMC9708930 DOI: 10.1136/neurintsurg-2022-018941] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/15/2022] [Indexed: 01/17/2023]
Abstract
The use of flow diverters is a rapidly growing endovascular approach for the treatment of intracranial aneurysms. All FDA-approved flow diverters are composed of nitinol or cobalt-chromium, which will remain in the patient for the duration of their life. Bioresorbable flow diverters have been proposed by several independent investigators as the next generation of flow diverting devices. These devices aim to serve their transient function of occluding and healing the aneurysm prior to being safely resorbed by the body, eliminating complications associated with the permanent presence of conventional flow diverters. Theoretical advantages of bioresorbable flow diverters include (1) reduction in device-induced thrombosis; (2) reduction in chronic inflammation and device-induced stenosis; (3) reduction in side branch occlusion; (4) restoration of physiological vasomotor function; (5) reduction in imaging artifacts; and (6) use in pediatric applications. Advances made in the similar bioresorbable coronary stenting field highlight some of these advantages and demonstrate the feasibility and safety of bioresorbable endovascular devices in the clinic. The current work aims to review the progress of bioresorbable flow diverters, identify opportunities for further investigation, and ultimately stimulate the advancement of this technology.
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Affiliation(s)
- Alexander A Oliver
- Biomedical Engineering and Physiology, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent D Carlson
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Cem Bilgin
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Roger J Guillory
- Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
| | - Dan Dragomir Daescu
- Biomedical Engineering and Physiology, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Biomedical Engineering and Physiology, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
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