Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review

Area of Science:

• Neuroendovascular treatment
• Cerebrovascular research
• Biomaterial-tissue interaction

Background:

• Flow diverters are used to treat cerebral aneurysms by inducing thrombosis and endothelialization.
• While hemodynamics are studied, the endothelium's role in aneurysm healing requires more focus.
• Understanding endothelialization is key to optimizing flow diverter efficacy.

Purpose of the Study:

• To systematically review literature on flow diverter mechanisms of action.
• To investigate the role of endothelialization in flow-diverter treatment of cerebral aneurysms.
• To synthesize findings from both human and preclinical studies.

Main Methods:

• Systematic literature search across major databases (PubMed, Cochrane, MEDLINE, EMBASE, Web of Science).
• Inclusion of studies assessing endothelialization in flow diverter therapy for cerebral aneurysms.
• Analysis of 10 eligible articles, including 2 human and 8 preclinical studies.

Main Results:

• Endothelialization is a critical component of flow diverter therapy.
• Optical coherence tomography and scanning electron microscopy were key assessment methods.
• Data primarily originates from preclinical models, with limited human patient data.

Conclusions:

• The precise origin of endothelial cells on flow diverters is still debated.
• Further research is needed to clarify the temporal relationship and cell source in humans.
• Endothelialization is essential for successful aneurysm exclusion and healing.