Testing the Medina embolization device in experimental aneurysms

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OBJECTIVE

The Medina embolization device (MED) is a novel, braided self-expanding endovascular device designed to occlude aneurysms by constructing an in situ intrasaccular flow diverter. Although a single device can be positioned at the neck of simple spherical in vitro aneurysms, the best way to occlude more complex in vivo aneurysms (using multiple MEDs or a combination of MEDs and platinum coils) is currently unknown.

METHODS

Fifty-two aneurysms of 3 different types were created in 31 canines, yielding 48 patent aneurysms. Treatments were randomly allocated by drawing lots: group 1, MEDs alone (n = 16); group 2, MEDs plus standard platinum coils (n = 16); and group 3, control aneurysms treated with coils alone (n = 16). Angiographic results were scored and compared immediately following treatment completion and at 3 months. Specimens were photographed and the extent of neointimal closure of the aneurysmal neck scored, followed by histopathological analyses.

RESULTS

Angiographic scores of 0 or 1 (occlusion or near occlusion) were initially obtained in 2 of 16 (12.5%, 95% CI 1.6%–38.3%) group 1 (MEDs alone), 3 of 16 (18.7%, 95% CI 4%–45.6%) group 2 (MEDs plus coils), and 10 of 16 (62.5%, 95% CI 35.4%–84.8%) group 3 (coils alone) aneurysms (p = 0.005). At 3 months, scores of 0 or 1 were found in 11 of 16 (68.7%, 95% CI 41.3%–89.0%) group 1, 9 of 16 (56.2%, 95% CI 29.9%–80.2%) group 2, and 8 of 16 (50%, 95% CI 24.7%–75.3%) group 3 aneurysms (p = 0.82). Neointimal scores were similar for the 3 treated groups (p = 0.66).

CONCLUSION

Endovascular treatment of experimental aneurysms with MEDs or MEDs and coils showed angiographic occlusion and neointimal scores at 3 months that were similar to those achieved with standard platinum coiling.

ABBREVIATIONS ASA = acetylsalicylic acid; CCA = common carotid artery; FD = flow diverter; HPS = hematoxylin, phloxine, and saffron; IFD = intrasaccular flow disruptor; MED = Medina embolization device.

Supplementary Materials

  • Supplementary Table and Figure (PDF 2.80 MB)
Article Information

Contributor Notes

Correspondence Jean Raymond: CHUM, Notre-Dame Hospital, Montreal, QC, Canada. jean.raymond@umontreal.ca.INCLUDE WHEN CITING Published online November 2, 2018; DOI: 10.3171/2018.5.JNS18326.Disclosures This work was supported by a research grant from Medtronic/Covidien. The funding source had no role in the study design or the drafting of the manuscript
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