Neurovascular Intervention

Reconsider forging ahead with repeated clot retrieval attempts, study suggests

NeuroVita's business covers three major fields of neurointerventional ischemia, hemorrhage and access, nine products have been marketed, and the company relies on its core research team and five core technology platforms to develop more than 20 innovative products, including: self-expanding intracranial drug stent, new generation blood flow guiding device, intracranial suction system, intracranial embolization stent, intracranial drug balloon, etc. Some core products will fill the gaps in China and reach international leading level.

赛诺神畅业务覆盖神经介入缺血、出血、通路三大领域，目前已上市九款产品，公司依托核心科研团队及五大核心技术平台，开展研发二十余款创新产品，包括：自膨式颅内药物支架、新一代血流导向装置、颅内抽吸系统、颅内取栓支架、颅内药物球囊等，部分核心产品将填补国内空白，达到国际领先水平。

TRA is a safe and effective route of endovascular access for MT. Experience with this technique improves its efficacy and efficiency. The introduction of a TRA-specific catheter expands the armamentarium of the neurointerventionalist and may facilitate lesion access during MT procedures. Continued development of radial-specific devices may further improve MT outcomes.

Failure to access the occlusion is a significant contributor to failed recanalization, regardless of access routes. Challenging, but eventually successful access is also a relevant factor in procedural and clinical outcomes; however challenging access requires a universal definition to enable quantification, so that methods for procedural optimization can be critically assessed.

The dense mesh stent is suitable for unruptured aneurysms, including wide carotid aneurysms, spindle aneurysms, and cystic aneurysms, etc. The product has international leading technology:

• It is made of ultra-fine cobalt-chromium-platinum composite wire, which can significantly reduce the material diameter with the same strength;
• Smaller profile, 0.021" I.D. microcatheter for the whole series and 0.017" I.D. microcatheter for the small size series;
• The use of nanoscale polymer electron graft coating technology, with excellent anti-thrombotic function;
• The product can be developed under X-ray to enhance the intraoperative visualization effect.

Clotting model in aneurysms with and without flow diverter devices have been studied. Thrombosis is modeled by the "fluid age" model through the lattice Boltzmann method. Thrombosis prediction model was tested on three aneurysms with stents. Rate occlusion is between 80% to 91% for a medium and large aspect ratio aneurysms. For very small aneurysms, aneurism occlusion is low.

Flow diverters have drastically changed the landscape of intracranial aneurysm treatment and are now considered first-line therapy for select lesions. Their mechanism of action relies on intrinsic alteration in hemodynamic parameters, both at the parent artery and within the aneurysm sac. Moreover, the device struts act as a nidus for endothelial cell growth across the aneurysm neck ultimately leading to aneurysm exclusion from the circulation.

ICAD is an important cause of morbidity in Asian populations and current guidelines recommend intensive drug therapy. Although the guideline recommendation level for endovascular treatment is not high, the exploration of endovascular treatment has not stopped after SAMMPRIS.

ICAD是亚洲人群发病的重要原因，目前指南推荐强化药物治疗。虽然指南对血管内治疗的推荐级别不高，但是在SAMMPRIS后一直未停止对血管内治疗的探索。

The first intracranial drug stent without neurotoxic safety. 6.66% restenosis at 1 year, a 73.4% reduction compared with bare stent, resulting in 88.4% reduction in recurrent stroke. Endothelial healing orientation, with 28-day drug peak and 60-day absorption completion.

首个无神经毒性安全性的颅内药物支架；1年再狭窄6.66%，同裸支架比降低73.4%，从而降低再发卒中88.4%；血管内皮愈合导向，28天药物峰值，60天吸收完毕。

Professor Liu Jianmin from the Cerebrovascular Disease Center of the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), with the concerted efforts and support of all investigators, completed the enrollment of all cases on February 8, 2023, i.e. only 7 months after the first case.

海军医科大学第一附属医院（上海长海医院）脑血管病中心的刘建民教授在所有研究人员的共同努力和支持下，于2023年2月8日完成了所有病例的入组工作，即距第一例病例仅7个月。

This review aims to provide a comprehensive understanding of and practical guidance on the modern use of micro- and nanotopography to control water; adhesion; wettability; biological adhesion, including implants, cell culture and biofouling; and directional fluid transport. The broad range of functionality is highlighted in the many interfacial interactions. However, the methods allowing economy of scale allowing these surfaces to be used commonly is still in development.

In terms of aspiration catheters, distal trackability and the combination of a low-profile outer diameter with a maximally large inner diameter is the goal. Many newer devices are addressing these issues. For stent retrievers, smaller devices need to be delivered via smaller microcatheters, but these too are commercially available. When using a combined approach, the main issue to consider is length when using various combinations of devices for a triaxial approach.

Binding properties of samples coated with all compounds were increased for DNA (≈3-fold) and decreased (≈5-fold) for blood elements, as compared with the bare alloy samples in vitro. Functional testing showed that surface modification with DNA-binding compounds improved clot retrieval and significantly reduced distal emboli during experimental MT of large vessel occlusion in a three-dimensional model.

Thrombus composition in stroke was highly heterogeneous, containing fibrin, platelets, red blood cells, VWF (von Willebrand Factor), and neutrophil extracellular traps. Thrombi could roughly be divided into fibrin- and red blood cell–rich clots. Fibrin-rich clots were associated with increased recanalization manoeuvres, longer procedure time, and less favorable clinical outcomes compared with red blood cell–rich clots. Advances in detection or treatment of thrombi that take into account clot heterogeneity may be able to improve future endovascular and thrombolytic treatment of stroke.

研发的远端通路导管正式获得国家药品监督管理局颁发的《中华人民共和国医疗器械注册证》。这款远端通路导管是由赛诺神畅自主研发并进行生产的第一款通路导管产品，商品名NOVARAIL™.

The distal access catheter developed by Sano is officially awarded the "Medical Device Registration Certificate of the People's Republic of China" by the State Drug Administration. This distal access catheter is the first access catheter developed and manufactured by NeuroVita under the trade name of NOVARAIL™.

Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers.

Knowing how fast and how much blood flows through a patient’s blood vessels is important because it can help clinicians diagnose various cardiovascular conditions, including blood clots; heart valve problems; poor circulation in the limbs; or blockages in the arteries that could lead to strokes or heart attacks.

A thrombus, known as a blood clot, may form within the vascular system of the body and impede blood flow. Thrombosis is the most common underlying pathology of cardiovascular diseases, contributing to high morbidity and mortality. However, the main thrombolytic drugs (urokinase, streptokinase, etc.) have shortcomings, including a short half-life, serious side effects and a lack of targeting, that limit their clinical application. The use of nano-drug delivery systems is expected to address these problems and a variety of approaches, including biological and physical responsive systems, have been explored.

Migraine is a complex brain disorder explained by the interaction of genetic and environmental factors. In monogenic migraines, including familial hemiplegic migraine and migraine with aura associated with hereditary small-vessel disorders, the identified genes code for proteins expressed in neurons, glial cells, or vessels, all of which increase susceptibility to cortical spreading depression. The study of monogenic migraines has shown that the neurovascular unit plays a prominent role in migraine. Genome-wide association studies have identified numerous susceptibility variants that each result in only a small increase in overall migraine risk.

This neurovascular disease is not only harmful but, unfortunately, common. Ischaemic stroke accounts for 85% of all strokes1 and, globally, one in four adults over the age of 25 will have a stroke in their lifetime.2 The impact of stroke can be short or long term, depending on which part of the brain is affected and how quickly it is treated. However, advancements in stroke research over the last decade have led to innovative and effective treatments, like mechanical thrombectomy, which is a minimally invasive procedure3 that offers positive benefits for patients after an ischaemic stroke—if applied in the first few hours after stroke onset.

For patients with large ischemic strokes, endovascular therapy is associated with improved outcomes, according to two studies published online Feb. 10 in the New England Journal of Medicine to coincide the annual American Stroke Association International Stroke Conference, held from Feb. 8 to 10 in Dallas.

Changes in real-world arm use after an ischemic stroke may be associated with changes in the corticospinal tract and white matter structures, such as the fornix and cingulate, related to the reward system and behavioral learning.

The researchers found that DAPT was prescribed at the time of discharge to 40 percent of patients overall. However, gender was a significant factor, with men more likely to get prescribed DAPT than women (43 versus 37 percent). Body mass index (BMI) did not have a lone effect on number of antiplatelets prescribed, but when it was included as a covariate, there was a significant effect seen on the number of antiplatelets prescribed. Higher BMI was associated with a lower likelihood of receiving DAPT. Differences were not significant for age, race, or whether or not the patient was discharged from a tertiary center.