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Published on: July 19, 2016
Jailed Artery Ostia Modifications After Flow-Diverting Stent Deployment at Arterial Bifurcations: A Scanning Electron
Christina Iosif1, Sebastien Ponsonnard, Antoine Roussie
1*Department of Interventional Neuroradiology, Dupuytren University Hospital, Limoges, France; ‡Applied Medical Research Team (ERMA), University of Limoges, Limoges, France; §Department of Anesthesiology, Dupuytren University Hospital, Limoges, France; ¶Faculty of Medicine, University of Limoges, Limoges, France; ‖Science of Ceramic Processes and Surface Treatments, CNRS, UMR 7315, European Ceramic Center, University of imoges, Limoges, France; #Research and Analysis Laboratory, Haute-Vienne, Limoges, France; **Department of Histology, Cytology, Cellular Biology, and Cytogenetics, Mother and Child (HME), University Hospital, Limoges, France.
Background:
Even though flow-diverting stents are being increasingly used to treat intracranial aneurysms, the fate of jailed side branches remains controversial, with recent clinical data contradicting finding of earlier animal studies that reported patency.
Objective:
To quantify the surface area of the ostia after 3 months of jailing by flow-diverting stents as a more accurate means of patency evaluation.
Methods:
Ten large white swine were stented by flow-diverting stents placed at common carotid-ascending pharyngeal arterial bifurcation sites. A dual antiplatelet regimen was initiated 72 hours before stenting and maintained during follow-up. Optical coherence tomography was used to search for per-procedural thrombus formation. Selective control digital subtraction angiography was performed 12 weeks post-stenting. Subsequently, the stented arterial segments were harvested en bloc and observed under scanning electron microscopy, photographed, and quantified.
Results:
The absence of per-procedural thrombus formation was confirmed. All ostia were patent at 12 weeks (or 3 months) post stenting, with no angiographic or scanning electron microscopy-evident thrombus formation. The mean initial ostium surface was 2 048 617 ± 731 625 μm. At 3 months, the mean nonendothelialized ostium surface was 229 218 ± 140 172 μm, and mean endothelialized ostium surface was 1 819 399 ± 672 632 μm. A statistically significant difference (reduction) was observed between the initial and 12-week ostium surfaces (P < .001), with an significant statistical power (1.000).
Conclusion:
Jailed side branches remained patent after stenting, but the surface quantifications showed significant endothelial coverage, with a significant reduction of patent ostium surfaces at 12 weeks post-stenting.
Abbreviations:
APhA, ascending pharyngeal arteryCI, confidence interval3DRA, 3-dimensional rotational angiographyDSA, digital subtraction angiographyFDS, flow-diverting stentOCT, optical coherence tomographyOS, ostium surfaceSEM, scanning electron microscopy.
