Longitudinal Monitoring of Flow-Diverting Stent Tissue Coverage After Implant in a Bifurcation Model Using Neurovascular High-Frequency Optical Coherence Tomography
Department of Radiology; New England Center for Stroke Research
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Nervous System Diseases | Neurosurgery | Radiology
BACKGROUND: Tissue growth over covered branches is a leading cause of delayed thrombotic complications after flow-diverter stenting (FDS). Due to insufficient resolution, no imaging modality is clinically available to monitor this phenomenon.
OBJECTIVE: To evaluate high-frequency optical coherence tomography (HF-OCT), a novel intravascular imaging modality designed for the cerebrovascular anatomy with a resolution approaching 10 microns, to monitor tissue growth over FDS in an arterial bifurcation model.
METHODS: FDS were deployed in a rabbit model (n = 6), covering the aortic bifurcation. The animals were divided in different groups, receiving dual antiplatelet therapy (DAPT) (n = 4), aspirin only (n = 1), and no treatment (n = 1). HF-OCT data were obtained in vivo at 3 different time points in each animal. For each cross-sectional image, metal and tissue coverage of the jailed ostium was quantified. Scanning electron microscopy images of harvested arteries were subsequently obtained.
RESULTS: Good quality HF-OCT data sets were successfully acquired at implant and follow-up. A median value of 41 (range 21-55) cross-sectional images were analyzed per ostium for each time point. Between 0 and 30 d after implant, HF-OCT analysis showed a significantly higher ostium coverage when DAPT was not given. After 30 d, similar growth rates were found in the DAPT and in the aspirin group. At 60 d, a coverage of 90% was reached in all groups.
CONCLUSION: HF-OCT enables an accurate visualization of tissue growth over time on FDS struts. The use of FDS in bifurcation locations may induce a drastic reduction of the jailed-branch ostium area.
Endothelialization, Flow diverter, Intracranial aneurysm, Optical coherence tomography, aspirin, stents, heart failure, follow-up, oryctolagus cuniculus, diagnostic imaging, optical coherence tomography, implants, aortic bifurcation, fluid flow, dual anti-platelet therapy, datasets
DOI of Published Version
Caroff J, King RM, Ughi GJ, Marosfoi M, Langan ET, Raskett C, Puri AS, Gounis MJ. Longitudinal Monitoring of Flow-Diverting Stent Tissue Coverage After Implant in a Bifurcation Model Using Neurovascular High-Frequency Optical Coherence Tomography. Neurosurgery. 2020 May 28:nyaa208. doi: 10.1093/neuros/nyaa208. Epub ahead of print. PMID: 32463884. Link to article on publisher's site
Caroff J, King RM, Ughi GJ, Marosfoi MG, Langan ET, Raskett CM, Puri AS, Gounis MJ. (2020). Longitudinal Monitoring of Flow-Diverting Stent Tissue Coverage After Implant in a Bifurcation Model Using Neurovascular High-Frequency Optical Coherence Tomography. Radiology Publications. https://doi.org/10.1093/neuros/nyaa208. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/547