Neurovascular Intervention

Platelet function monitoring–guided antiplatelet therapy reduces thromboembolic events in patients with unruptured intracranial aneurysm after stent placement, significantly enhancing minor or minimal bleeding events but not major bleeding events.

Endovascular treatment is the first-line therapy for most intracranial aneurysms; however, recanalisation remains a major limitation. Developments in bioengineering and material science have led to a novel generation of coil technologies for aneurysm embolisation that address clinical challenges of aneurysm recurrence. This review presents an overview of modified surface coil technologies and summarises the state of the art regarding their efficacy and limitations based on experimental and clinical results. We also present potential perspectives to develop biologically optimised devices.

Purpose Aneurysm recanalization constitutes a limitation in the endovascular treatment of intracranial aneurysms using conventional bare platinum coils. The development of platinum coils coupled with hydrogel polymers aimed at decreasing the rates of recurrence by way of enhanced coil packing density and biological healing within the aneurysm. While enhanced occlusion and durability has been shown for the first generation hydrogel coils, their use was limited by technical challenges. Less data is available regarding the second-generation hydrogel coils which have been designed to perform like bare platinum coils.

For patients undergoing endovascular thrombectomy for large vessel occlusion stroke, those presenting in the early window have better outcomes with use of a Mobile Interventional Stroke Team (MIST) model of treatment, according to a study published online Aug. 5 in Stroke.

In a paper authored by Carmen Serna-Candel (Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany) et al, the outcomes of the pRESET 4×20 and pRESET 5×40 stentrievers (both Phenox) were examined against one another. The results “speak for themselves”, a Phenox press release states, and add to existing evidence that longer stentrievers lead to better patient outcomes.
With the use of the longer stentriever, a significant improvement in recanalisation rates was observed, along with improved mortality rates and fewer passes required to full recanalisation. First pass success was seen in 68.4% of cases with the pRESET 5×40 while the pRESET 4×20 resulted in first pass success in 48.7% of cases.

The use of flow diverter devices to treat intracranial aneurysms dates back roughly a full decade to the US Food and Drug Administration (FDA) granting Covidien premarket approval for its Pipeline embolisation device (PED) in 2011—a company and, therefore, a technology, that has since been acquired by Medtronic. This has made Medtronic and the PED frontrunners in the field, and fresh evidence on this device is still emerging 10 years on, with data on 1,000 aneurysms from a single-centre registry, published in Neurosurgery in June 2021, concluding that it is safe and effective at up to 13 years of follow-up.

“Endovascular thrombectomy is no longer just about removing the clot,” said Hal Rice, director of Interventional Neuroradiology at GCUH (Gold Coast, Australia). “To get the best result for your patient, you need to get the clot out with complete revascularisation the first time. The Clotild guidewire is the first device that promises to provide live real-time information during the intervention that can help to increase our chances of choosing the right intervention approach from the get-go.”

Pierot began by reporting that the COATING study will assess the phenox Hydrophilic Polymer Coating (pHPC)—which is designed to modify the surface of a flow diverter in order to reduce platelet aggregation, and minimise complications like intra-stent thrombosis and distal emboli without the need for dual antiplatelet therapy (DAPT) alongside these devices.

Uptake of flow-diverting technology is rapidly outpacing the availability of clinical evidence. Most current usage is off-label, and the endovascular community is nearer the beginning than the end of the learning curve, given the number of devices in development. A comprehensive overview of technical specifications alongside key outcome data is essential both for clinical decision-making and to direct further investigations. Most-studied has been the Pipeline Embolization Device, which has undergone a transition to the Pipeline Flex for which outcome data are sparse or heterogeneous. Alternative endoluminal devices do not appear to be outperforming the Pipeline Embolization Device to date, though prospective studies and long-term data mostly are lacking, and between-study comparisons must be treated with caution.

Autofluorescence, endothelial cells and second harmonic generation (SHG) signals from biological tissues were used to evaluate the endovascular treatment of intracranial aneurysms. Improved label-free multiphoton microscopy quantification of FDS integration into the arterial wall.

In patients with an acute anterior circulation stroke, modern device thrombectomy significantly reduces death and subsequent disability. The magnitude of these effects suggests that universal access to this treatment strategy should be the standard of care.

We postulate that factors related to mobility, especially reduced physical activity and reduced general infection due to social distancing measures, may significantly contribute as with rising mobility we observe higher stroke consultations in our telestroke network. This effect may potentially complicate stroke treatment with regard to a “second wave.” Larger datasets on both, epidemiological data and behavioral changes during the COVID-19 pandemic are needed to shed light into this phenomenon.

High-resolution flat-detector computed tomography (HR-FDCT) improves visualization of the fine structures of intracranial stents deployed for symptomatic ICAS compared with that visualized using conventional FDCT. High-resolution flat-detector computed tomography improves assessment of stent deployment and could reduce the risk of complications.

Register! Demo scheduled in the October 5-7 2021 session. SLICE Worldwide is an international audio-visual and interactive event focused on the treatment and care of strokes. Its objective is to offer an opportunity for constructive dialogue on practical and concrete cases.

Femtosecond lasers have been used in institutions and research centers for more than 30 years, but commercial-ready femtosecond technology that can last in an industrial environment that runs 24/7 has been available for less than a decade. Once considered too slow for commercial operations, they recently were the subject of a study that evaluated cutting time per part and postprocessing steps. The study demonstrated that the return on investment for a disk femtosecond laser can be less than 12 months in many cases, especially for high-value components.

Stenting of arteries as a percutaneous transluminal angioplasty procedure became a promising minimally invasive therapy based on re-opening narrowed arteries by stent insertion. In order to improve and optimize this method, many research groups are focusing on designing new or improving existent stents. Since the beginning of the stent development in 1986, starting with bare-metal stents (BMS), these devices have been continuously enhanced by applying new materials, developing stent coatings based on inorganic and organic compounds including drugs, nanoparticles or biological components such as genes and cells, as well as adapting stent designs with different fabrication technologies. Drug eluting stents (DES) have been developed to overcome the main shortcomings of BMS or coated stents. Coatings are mainly applied to control biocompatibility, degradation rate, protein adsorption, and allow adequate endothelialization in order to ensure better clinical outcome of BMS, reducing restenosis and thrombosis.

Supraflex™ has the lowest strut (60µm) thickness among all the available sirolimus eluting coronary stents, without compromising radial strength. Flexible ‘S’-link provides unparalleled flexibility, deliverability and vessel conformability allowing you to deal with the most complicated anatomies.

University of California San Diego (UCSD) engineers have developed a smart skin patch that can detect blood clots and other concerning cardiovascular conditions. The soft patch uses ultrasound nanotechnology to provide a comprehensive picture of how blood flows through deep arteries and veins.

Endoluminal flow diversion is an important tool in the treatment of posterior circulation aneurysms. Patient age, aneurysm size, prior treatment, and the number of flow diverters used are important factors associated with complications and outcomes.

据悉，我国25岁以上人群，每10人中就有近4人受到脑卒中的威胁；每5位死亡者中至少由1人死于脑卒中。颅内动脉瘤是发生在颅内动脉管壁上的异常膨出，一旦发生破裂，患者的死亡率、致残疾率都非常高。Tubridge®针对临床难以治疗的大型、巨大型动脉瘤研发设计，通过利用“血流动力学”原理改变动脉瘤内血流流态，降低血流对动脉瘤的冲击，使内皮细胞沿支架骨架生长，逐渐修复动脉瘤瘤颈，治愈动脉瘤，从而排除“颅内不定时炸弹”。Tubridge®是第一个获批进入国家药品监督管理总局（NMPA）创新医疗器械特别审批程序（绿色通道）的神经介入产品，也是目前唯一一款国产血流导向装置。上市三年多以来，Tubridge® 6个月的治愈率达到75%，远超传统的进口弹簧圈加支架治疗的24%。

Senescent cells are capable of expressing a myriad of inflammatory cytokines and this pro-inflammatory phenomenon is known as senescence-associated secretory phenotype (SASP). The contribution of this phenomenon in brain ischemia was scarce.

Objective To determine whether the association between increasing number of clot retrieval attempts (CRA) and unfavorable outcome is due to an increase in emboli to new territory (ENT) and greater infarct growth (IG) in successfully recanalized patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).

In ICAS patients with stenosis of at least 70%, even with aggressive medical therapy, the annual stroke recurrence rate is 10%-20% in those with occlusions and at least three or more vascular risk factors. This high rate of recurrent vascular events in patients with stroke caused by ICAS warrants greater focus on primary prevention and targeted interventions for stroke-free individuals at highest risk for ICAS-related events, the investigators concluded.

Ischemic stroke is a cerebrovascular disease normally caused by interrupted blood supply to the brain. Ischemia would initiate the cascade reaction consisted of multiple biochemical events in the damaged areas of the brain, where the ischemic cascade eventually leads to cell death and brain infarction. Traditional treatment methods based on antithrombotic therapy and neuroprotective therapy are greatly limited for their poor safety and treatment efficacy. Nanomedicine provides new possibilities for treating stroke as they could improve the pharmacokinetic behavior of drugs in vivo, achieve effective drug accumulation at the target site, enhance the therapeutic effect and meanwhile reduce the side effect.

Asymptomatic intracranial atherosclerotic stenosis (ICAS) increased the risk of vascular events in people who were stroke-free at baseline, prospective data showed. People with ICAS of 70% or more had a HR for a composite of vascular death, any stroke, or myocardial infarction of 2.1 (95% CI 1.4-3.2) and an annual risk of vascular events of 5.5%, compared with people who did not have ICAS.