Acute Thrombus Burden on Coated Flow Diverters Assessed by High Frequency Optical Coherence Tomography
New England Center for Stroke Research; Department of Radiology
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Nervous System Diseases | Neurology | Radiology
PURPOSE: The implantation of flow diverters requires administration of dual anti-platelet therapy, posing the potential for complications. The p48MW HPC (phenox, Bochum, Germany) hydrophilic-coated flow diverting stent is designed to be anti-thrombotic, thus opening the potential for single anti-platelet therapy. We deploy a novel intravascular high-resolution imaging technique, high-frequency optical coherence tomography (HF-OCT), to study in an animal model the acute thrombus formation on coated p48MW devices versus uncoated control devices.
METHODS: Three pigs were implanted with 4 flow diverters each, two test hydrophilic-coated devices, and two control uncoated devices (p48MW). Each pig was treated with a different anti-platelet regime: no anti-platelet therapy, aspirin only, aspirin and clopidogrel. Twenty minutes after the flow diverter was implanted, an HF-OCT data set was acquired. Acute clot formed on the flow diverter at each covered side branch was measured from the HF-OCT slices. Factors considered to be important were the device type (pHPC versus bare metal), aspirin, clopidogrel, and vessel location. A linear model was constructed from the significant factors.
RESULTS: Both coating (p < 0.001) and aspirin (p = 0.003) were significantly related to reduction in clot burden, leading to an approximate 100-fold and 50-fold reduction in clot, respectively.
CONCLUSIONS: This study shows the power of HF-OCT not only in the detection of clot but also the quantification of clot burden. In an animal model, the pHPC-coated p48MW significantly reduced acute thrombus formation over jailed side branches as compared to the bare metal p48MW that was nearly eliminated when combined with aspirin administration.
Flow diverter, Hydrophilic coating, Optical coherence tomography, Stents, Thrombus
DOI of Published Version
King RM, Langan ET, Ughi GJ, Raskett CM, Puri AS, Henkes H, Gounis MJ. Acute Thrombus Burden on Coated Flow Diverters Assessed by High Frequency Optical Coherence Tomography. Cardiovasc Intervent Radiol. 2020 May 8. doi: 10.1007/s00270-020-02482-w. Epub ahead of print. PMID: 32385610. Link to article on publisher's site
Cardiovascular and interventional radiology
King RM, Langan ET, Ughi GJ, Raskett CM, Puri AS, Henkes H, Gounis MJ. (2020). Acute Thrombus Burden on Coated Flow Diverters Assessed by High Frequency Optical Coherence Tomography. Radiology Publications. https://doi.org/10.1007/s00270-020-02482-w. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/538