Tim E. Darsaut, Fabrice Bing, Igor Salazkin, Guylaine Gevry and Jean Raymond
Flow diverters (FDs) are increasingly used to treat complex intracranial aneurysms, but preclinical studies that could guide clinical applications are lacking. The authors designed a modular aneurysm model in canines to address this problem.
Three variants of one modular aneurysm model were constructed in 21 animals. Sidewall (n = 5), curved sidewall (n = 5), and end-wall bifurcation (n = 7) aneurysms were treated with prototype 36-wire FDs. Four more end-wall bifurcation aneurysms were treated with prototype 48-wire lower-porosity FDs. Angiographic results postimplantation and at 3 months were scored with an ordinal scale. Animals were euthanized at 3 (n = 17) or 6 (n = 3) months, and the FD covering the aneurysm ostium was photographed to analyze metallic porosity and amount of neointima formation.
Straight sidewall aneurysms were better occluded than curved sidewall and end-wall bifurcation aneurysms at the 3-month angiography follow-up (p = 0.010). Flow diverters failed to occlude curved sidewall aneurysms (n = 0/5) and all but one (n = 1/7) end-wall bifurcation aneurysm. Angiographic results were no better (n = 0/4) using a 48-wire FD (p = 0.788). Branches jailed by the FD (n = 16) remained patent in all cases. Metallic porosity was decreased (p = 0.014) and neointimal closure of the aneurysm ostium was more complete (p = 0.040) in sidewall aneurysms than in curved or bifurcation variants of the model.
Flow diverters may succeed in treating straight sidewall aneurysms, but the same device repeatedly fails to occlude curved sidewall and end-wall bifurcation aneurysms. In vivo studies can be designed to test basic principles that, once validated, may serve to guide clinical use of new devices.
Xavier Boileau, Han Zeng, Robert Fahed, Fabrice Bing, Alina Makoyeva, Tim E. Darsaut, Pierre Savard, Benoit Coutu, Igor Salazkin and Jean Raymond
Endovascular treatment of aneurysms may result in incomplete initial occlusion and aneurysm recurrence at angiographic follow-up studies. This study aimed to assess the feasibility and efficacy of bipolar radiofrequency ablation (RFA) of aneurysm remnants after coil embolization.
Bipolar RFA was accomplished using the coil mass as 1 electrode, while the second electrode was a stent placed across the aneurysmal neck. After preliminary experiments and protocol approval from the Animal Care committee, wide-necked bifurcation aneurysms were constructed in 24 animals. Aneurysms were allocated to 1 of 3 groups: partial intraoperative coil embolization, followed by RFA (n = 12; treated group) or without RFA (n = 6; control group 1); or attempted complete endovascular coil embolization 2–4 weeks later (n = 6; control group 2). Angiographic results were compared at baseline, immediately after RFA, and at 12 weeks, using an ordinal scale. Pathological results and neointima formation at the neck were compared using a semiquantitative grading scale.
Bipolar RFA was able to reliably target the aneurysm neck when the coil mass and stent were used as electrodes. RFA improved angiographic results immediately after partial coiling (p = 0.0024). Two RFA-related complications occurred, involving transient occlusion of 1 carotid artery and 1 hemorrhage from an adventitial arterial blister. At 12 weeks, angiographic results were improved with RFA (median score of 0), when compared with controls (median score of 2; p = 0.0013). Neointimal closure of the aneurysm neck was better with RFA compared with controls (p = 0.0003).
Bipolar RFA can improve results of embolization in experimental models by selectively ablating residual lesions after coil embolization.