Neurovascular Intervention

Discussions at this year’s European Society of Minimally Invasive Neurological Therapy (ESMINT) congress (4–6 September, Marseille, France) revealed the extent of the disparities between the current regulatory systems in Europe and the USA, with experts and attendees outlining how “the tables have turned” over the past few years, potentially enticing more neurovascular device manufacturers to seek US Food and Drug Administration (FDA) clearance as their first port of call.

The focal point of Anaconda’s product portfolio is the ANA5 advanced neurovascular access thrombectomy device, which is specifically designed for use in the anterior and posterior neurovascular vessels—including the internal carotid artery, the M1 and M2 segments of the middle cerebral artery, the basilar artery, the posterior cerebral artery, and the vertebral arteries. ANA5 comprises an aspiration funnel catheter featuring variable stiffness sections to be used in conjunction with a stent retriever. The funnel catheter consists of a radiopaque nitinol braid covered with a silicone coating to enable local flow restriction.

Studies have shown the benefits of endovascular treatment (EVT) in adult stroke cases, but its application in pediatric stroke remains controversial. Despite evidence of improved outcomes in adults, there are no established recommendations for EVT in children. Conducting individual case reports and case series is vital to understanding its potential advantages and disadvantages in this context.

During mechanical thrombectomy, distal base catheter placement makes more sense because you have to [achieve] shorter distances from the base catheter to the intracranial space where the clot is located.

This marks the official start of the First In Man (FIM) clinical trial of Nufairy™ absorbable embolic spring coil for the treatment of intracranial aneurysm in Shanghai Changhai Hospital, and the first case of implantation of absorbable embolic spring coil in the world. The successful completion of the surgery not only fully demonstrates the innovative spirit of Cerebrovascular Disease Center of Changhai Hospital in the field of intracranial aneurysm interventional therapy, but also means that the treatment of intracranial aneurysm in China is accelerating towards a new era of precision.

Fluid Biomed Inc., a medical device company developing ReSolv™, the world's first hybrid polymer-metal flow-diverting stent to treat brain aneurysms, announces the international launch of REDIRECT, its first-in-human clinical trial. Phase 1 of this technical feasibility and safety study has begun with successful device implantation without adverse effect in human subjects at the pre-determined 30-day time point and recruitment is on-going.

Fluid Biomed is commercializing the first polymer-based brain stent to cure aneurysms. Brain aneurysms afflict up to 5% of people and can lead to devastating stroke. The company team of neurosurgeons, scientists, and engineers has designed the world’s first hybrid polymer-metal flow-diverting stent to cure this deadly disease. Uniquely constructed of dissolving polymer and metal, this innovative medical device provides a scaffold to allow better healing and visualization of blood vessels.

Membrane-distal CD31 domains 1 and 2 peptides exhibited a distinct capability to foster a healthy endothelial phenotype in vitro. By day 7 post-aortic implantation, CoCr stents were evenly covered by whole-some endothelial cells, devoid of thrombo-inflammatory signs, in contrast to both bare metal and drug-eluting stents. At day 60, nitinol-coated flow diverters demonstrated enhanced performance in comparison to the control groups for excluding experimental carotid aneurysms, facilitating the formation of a seamless "neo-arterial" wall. Conclusion: Membrane-distal CD31 biomimetic peptides effectively camouflage the device surface, prevent-ing local reactions and promoting rapid and seamless endovascular integration.

Aspirin remains the cornerstone of antiplatelet therapy in patients with cardiovascular disease. It decreases mortality and recurrence of cardiovascular events when used as acute therapy following acute coronary syndrome, thrombotic stroke, and Kawasaki's disease. It is also of proven benefit in secondary prevention among a wide range of patients, including those with acute coronary syndrome, stable angina, revascularization, stroke, TIA, and atrial fibrillation. In primary prevention, aspirin therapy appears to reduce the risk for CVD events in adults without a history of CVD with sex specific benefits. Aspirin may be considered for patients with a high risk of future CVD, but the benefits must be weighed against the possibility of side effects.

Inflammation and oxidative stress crosstalk is involved in the ischemic stroke(IS) pathogenesis and the new therapeutic options should be offered based on the targets that are critical in the golden hour of IS. YKL-40 and total antioxidant capacity(TAC), the inflammation and oxidative stress biomarkers, provide us with clues for proper intervention targets. N-acetyl cysteine amide (NACA), a lipophilic antioxidant, with a nanoparticle-based drug delivery system is permeable enough to penetrate blood-brain barrier (BBB) and was proposed as a new treatment option for IS.

Occlusive arteriosclerotic disease involving the intracranial cerebral vessels can be managed medically with antiplatelet and anticoagulant drug therapy or surgically. However, in patients who are unresponsive to medical therapy or who have unacceptable surgical risks, percutaneous transluminal angioplasty is an attractive alternative that can be performed in selected patients with relatively low risk and good clinical outcome.

Endovascular treatments, such as balloon angioplasty alone, balloon-mounted stents, and self-expandable stents, may be of benefit for carefully selected ICAS patients. Two prospective, multicenter, RCT are presently underway to re-evaluate the benefits of endovascular treatments in carefully selected patients (CASSISS trial, and the Wingspan Stent System Post-Market Surveillance Study (WEAVE) trial) (70, 71). These trials' strict selection criteria, identification of stroke mechanisms of intracranial atherosclerosis, as well as use of experienced neurointerventionists in high-volume centers are what makes them of interest for the re-evaluation of invasive ICAS treatment.

Nanomedicine has ushered in an exciting era in the diagnosis and treatment of ischemic stroke, which places an immense burden on society and families. PLGA is a nanomaterial with relative safety and a high plasticity widely used in pharmaceutical products and medical devices. In this paper, we review recent research on PLGA-based nanostructures, highlighting their great potential in drug delivery, disease therapy, cell transplantation, and the diagnostic imaging of ischemic stroke. Particularly, PLGA nanocarriers can carry drugs that are hard to transport into the brain across the blood–brain barrier to stroke lesions for targeted therapy. Nevertheless, the vast majority of current studies are preclinical.

In 2013, it was reported that pulsed radiofrequency (PRF) could be applied to obtain a systemic anti-inflammatory effect. Patients with chronic pain and patients with an inflammatory condition from other disciplines could potentially profit from this finding. At that time, intravenous application was used, but since then, it became clear that it could be applied transcutaneously as well. This procedure was named RedoxPRF. This can be used both for regional and for systemic application. Recently, the basic element of the mode of action has been clarified from the analysis of the effects of PRF on a standard model of muscle injury in rats.

In this population of older adults, low-dose aspirin did not reduce the risk of ischemic stroke, but did increase the risk of intracranial bleeding

Recipients of red blood cell transfusions from donors who later had multiple intracerebral hemorrhages (ICHs) had a significantly increased risk of spontaneous ICH themselves, an exploratory retrospective cohort study showed.

Although the concept of preconditioned EVs is relatively novel, it holds promise for the future treatment of ischemic stroke. Here, we give a brief overview about the main mechanisms of EV-induced neuroprotection and discuss the current status of preconditioning concepts for EV-treatment of ischemic stroke.

Here, we review the biogenesis of exosomes and their molecular composition and role as messengers of intercellular communication and describe using exosomes for treatment of stroke. We also focus on therapeutic effects and underlying mechanisms of action of exosomes as therapeutic vectors for stroke but do not discuss the role of exosomes as disease or injury biomarkers.

Sino Medical Sciences Technology, a Chinese manufacturer and distributor of medical devices, will buy a controlling stake in US peer eLum Technologies for USD20.7 million to replenish its product lines of instruments for coronary artery diseases and core technology reserves. SinoMed will purchase a 72 percent stake in eLum from Decheng Capital Global Life Sciences Fund IV, the Tianjin-based company announced yesterday, citing an equity transfer agreement the parties inked.

Stroke medicine has evolved rapidly in the past 30 years, epitomised by the considerable difference that mechanical thrombectomy has made to the lives of patients. In the early 2000s, the emphasis was on proving that thrombectomy was safe and possible. The HERMES collaboration justified its superiority and use in a tightly selected cohort of patients. In the past seven years, we have come a long way in expanding the initial selection criteria. As our technology, infrastructure, and understanding improves, the most pressing priority now is equal access for all appropriate patients, for this ground breaking treatment.

Balloons and stents have both been used as adjunctive, supporting devices during coil embolisation procedures, with Pierot and many of his colleagues in France preferring the former technique, while those in the USA and Germany are traditionally more reluctant to use balloon-assisted coiling and thus tend to gravitate towards stenting.

Much of the clinical success that can be achieved with aspiration-based mechanical thrombectomy is dependent on the characteristics and features of the specific device being used. In an effort to elucidate precisely how these factors actually impact device performance and, ultimately, thrombectomy outcomes, Paolo Machi (University Hospital of Geneva, Geneva, Switzerland) has published findings on a wealth of laboratory testing carried out by him and his colleagues in recent years.

Tigertriever technology, which Rapid claims has been “fuelled by advancements in aerospace engineering”, enables precise control during mechanical thrombectomy procedures. Its unique operation changes these procedures from a passive to an active approach that accelerates clot capture, and potentially reduces the risk of vascular injury during removal, the company further states, also noting that comparable, leading stent retrievers are “self-expanding and static”, and can therefore lead to suboptimal clot removal and minimal vessel protection.

Data are from the HERMES collaboration, a patient-level meta-analysis of seven randomized EVT trials. Baseline characteristics and functional outcomes (modified Rankin Scale (mRS) score at 90 days) were compared between patients with poor reperfusion (defined as modified Thrombolysis in Cerebral Infarction Score 0–1 on the final intracranial angiography run as assessed by the central imaging core laboratory) and patients in the control arm with multivariable logistic ordinal logistic regression adjusted for pre-specified baseline variables.

Several types of stem cells are available for the treatment of stroke patients. However, the optimal type of stem cell remains unclear. Using stem cell transplantation was associated with reduced risk of death and improved functional outcomes in patients with ischemic stroke. Additional large trials are warranted to provide more conclusive evidence.