Role of terminal and anastomotic circulation in the patency of arteries jailed by flow-diverting stents: animal flow model evaluation and preliminary results

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  • 1 Departments of Interventional Neuroradiology and
  • 4 Anesthesiology, Dupuytren University Hospital (CHU Limoges);
  • 2 Applied Medical Research Team (ERMA);
  • 5 Science of Ceramic Processes and Surface Treatments, CNRS, UMR 7315, European Ceramic Center, University of Limoges;
  • 6 Research and Analysis Laboratory, Haute-Vienne;
  • 7 Department of Histology, Cytology, Cellular Biology and Cytogenetics, Mother and Child (HME) University Hospital, Limoges, France; and
  • 3 Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg “Otto von Guerike,” Magdeburg, Germany
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OBJECTIVE

The authors describe herein the creation of an animal model capable of producing quantifiable data regarding blood flow rate and velocity modifications in terminal and anastomotic types of cerebrofacial circulation. They also present the preliminary results of a translational study aimed at investigating the role of terminal and anastomotic types of circulation in arterial branches jailed by flow-diverting stents as factors contributing to arterial patency or occlusion.

METHODS

Two Large White swine were used to validate a terminal-type arterial model at the level of the right ascending pharyngeal artery (APhA), created exclusively by endovascular means. Subsequently 4 Large White swine, allocated to 2 groups corresponding to the presence (Group B) or absence (Group A) of terminal-type flow modification, underwent placement of flow-diverting stents. Blood flow rates and velocities were quantified using a dedicated time-resolved 3D phase-contrast MRA sequence before and after stenting. Three months after stent placement, the stented arteries were evaluated with digital subtraction angiography (DSA) and scanning electron microscopy (SEM). Patent (circulating) ostia quantification was performed on the SEM images.

RESULTS

Terminal-type flow modification was feasible; an increase of 75.8% in mean blood velocities was observed in the right APhAs. The mean blood flow rate for Group A was 0.31 ± 0.19 ml/sec (95% CI −1.39 to 2.01) before stenting and 0.21 ± 0.07 ml/sec (95% CI −0.45 to 0.87) after stenting. The mean blood flow rate for Group B was 0.87 ± 0.32 ml/sec (95% CI −1.98 to 3.73) before stenting and 0.76 ± 0.13 ml/sec (95% CI −0.41 to 1.93) after stenting. Mean flow rates after stenting showed a statistically significant difference between Groups A and B (Welch test). Mean and maximal blood velocities were reduced in Group A cases and did not decrease in Group B cases. Control DSA and SEM findings showed near occlusion of the jailed APhAs in both cases of anastomotic circulation (mean patent ostium surface 32,776 μm2) and patency in both cases of terminal-type circulation (mean patent ostium surface 422,334 μm2).

CONCLUSIONS

Terminal-type arterial modification in swine APhAs is feasible. Sufficient data were acquired to perform an a priori analysis for further research. Flow diversion at the level of the APhA ostium resulted in significant stenosis in cases of anastomotic circulation, while sufficient patency was observed in terminal-type circulation.

ABBREVIATIONSAPhA = ascending pharyngeal artery; CCA = common carotid artery; CFD = computational fluid dynamics; DSA = digital subtraction angiography; ECA = external carotid artery; FDS = flow-diverting stent; pcMRA = phase contrast MR angiography; PED = Pipeline embolization device; RM = rete mirabile; SEM = scanning electron microscopy.

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Contributor Notes

INCLUDE WHEN CITING Published online January 15, 2016; DOI: 10.3171/2015.8.JNS151296.

Correspondence Christina Iosif, 2 Avenue Martin Luther King, Limoges 87042, France. email: christina.iosif@gmail.com.
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