Neurovascular Intervention

The Flow Redirection Endoluminal Device stent system (FRED; MicroVention)—a flow diverter used to treat intracranial aneurysms—has been deemed safe and effective for this indication, following a multicentre pivotal trial designed to support an application for US Food and Drug Administration (FDA) approval. The results of this study are published in the Journal of NeuroInterventional Surgery (JNIS).

Thrombosis is a major complication of cardiovascular disease, leading to myocardial infarction, acute ischemic stroke (AIS), or venous thromboembolism. Thrombosis occurs when a thrombus forms inside blood vessels disrupting blood flow. Developments in thrombectomy to remove thrombi from vessels have provided new opportunities to study thrombus composition which may help to understand mechanisms of disease and underpin improvements in treatments.

In a pilot program in New York City, instead of transferring stroke patients to a specialized stroke center, a mobile interventional stroke team (MIST) traveled to the patient to perform emergency stroke surgery resulting in significantly less disability for patients three months after the stroke, compared to patients who lost valuable time in the transfer to a higher level stroke center, according to new research published today in Stroke.

目前治疗颅内动脉粥样硬化性狭窄的主要手段有药物治疗、血管内介入治疗。研究表明，药物治疗短期安全性较好，但长期卒中复发率仍较高，且对于颅内动脉狭窄程度较高（狭窄≥70%，≤99%）患者的治疗效果不显著。血管内介入治疗由于创伤较小，术后血管即刻开通率高，但一年内支架再狭窄率较高。该产品中雷帕霉素可抑制血管平滑肌细胞的过度增生，降低支架内再狭窄发生率，从而减少远期再发卒中的风险。目前国内外市场尚无设计和预期用途相似的其他同类产品上市。

Secondary brain injury impacts patient prognosis and can lead to long-term morbidity and mortality in cases of trauma. Continuous monitoring of secondary injury in acute clinical settings is primarily limited to intracranial pressure (ICP); however, ICP is unable to identify essential underlying etiologies of injury needed to guide treatment (e.g. immediate surgical intervention vs medical management). Here we show that a novel intracranial bioimpedance monitor (BIM) can detect onset of secondary injury, differentiate focal (e.g. hemorrhage) from global (e.g. edema) events, identify underlying etiology and provide localization of an intracranial mass effect.

Women have more strokes, and are more likely to have symptoms such as fatigue and mental confusion rather than classic indications such as paralysis. Women also tend to have more severe strokes, according to the authors of a new study.

Our flagship product, the Stentrode™, is a minimally-invasive brain-computer interface currently being investigated in a clinical trial involving people affected by severe paralysis. Our first-in-human study has thus far demonstrated that patients with ALS were able to use the Stentrode to text, email, shop and bank online through direct thought, improving their functional independence. This research is ongoing.

Surmodics recently announced that it has acquired privately-held Vetex Medical Limited. The Galway, Ireland-based medical device developer and manufacturer has focused exclusively on venous clot removal solutions. The transaction expands Surmodics’ thrombectomy portfolio with a second US Food and Drug Administration (FDA) 510(k)-cleared device, the ReVene thrombectomy catheter.

Repeated clot retrieval attempts are associated with an increased rate of emboli to new territory (ENT) and greater infarct growth—resulting in poorer functional outcomes in acute ischaemic stroke patients even after successful recanalisation has been achieved. These findings are based on data from two pooled, multicentric prospective patient registries and are published in Neurology, the medical journal of the American Academy of Neurology (AAN).

Stent-assisted coiling with the Neuroform Atlas Stent is a viable alternative to clipping for selected MCA aneurysms. Complete aneurysm occlusion rates have improved compared to historical data. Proper case selection can lead to acceptable endovascular results.

ORIGIN SC is a semi-compliant (SC) PTCA balloon with a very low crossing profile, making it an excellent choice for challenging lesions. ORIGIN SC offers one of the broadest portfolio of sizes available for an SC balloon, including 1.00 mm, 1.25 mm, 1.50 mm and 1.75 mm balloon diameters to treat very small vessels and complex cases.

药物洗脱球囊（DCB）结合了球囊成型技术与药物洗脱技术，将抑制细胞增生的药物附着在球囊表面，通过膨胀球囊，将药物输送到病变局部血管壁内，以达到抑制平滑肌增生的作用。

作为“介入无植入”概念的一种新兴技术，药物洗脱球囊被用于冠状动脉与外周动脉介入手术中。与药物洗脱支架（DES）相比，它治疗冠状动脉小血管病变、分支病变、支架内再狭窄（ISR）等的效果更好。

The potential of CD31 as a therapeutic target in atherosclerosis has been considered ever since its cloning in the 1990s, but the exact role played by this molecule in the biologic events underlying atherosclerosis has remained controversial, resulting in the stalling of any therapeutic perspective. Due to the supposed cell adhesive properties of CD31, specific monoclonal antibodies and recombinant proteins were regarded as blocking agents because their use prevented the arrival of leukocytes at sites of acute inflammation.

Vivasure Medical®, a company pioneering novel fully absorbable technology for percutaneous vessel closure, today announced its development program for PerQseal® Blue, the company’s new investigational product. PerQseal Blue is designed exclusively for sutureless and fully absorbable large-bore venous vessel closure following percutaneous cardiovascular procedures, such transcatheter mitral valve repair or replacement (TMVR) and transcatheter tricuspid valve repair or replacement (TTVR). The PerQseal Blue technology is based on PerQseal, the company’s vascular closure device approved in Europe for use in femoral arteries.

Despite contemporary advances in stent technology, in-stent restenosis (ISR) remains a common issue following percutaneous coronary intervention. A novel classification system based on underlying mechanism of action of restenosis was recently introduced. The Waksman In-Stent Restenosis Classification characterizes different patterns of ISR to best delineate the type of restenosis and help guide treatment. Intravascular imaging with either intravascular ultrasound or optical coherence tomography allows for real-time evaluation of ISR.

The in-silico trial had 82 virtual cases, while the selected traditional clinical trials (PUFS [Pipeline for uncoilable or failed aneurysms], PREMIER [Prospective study on embolisation of intracranial aneurysms with the pipeline device], and ASPIRe [Aneurysm study of pipeline in an observational registry]) featured 109, 141 and 207 patients, respectively. Around half the cases in the traditional trials had high blood pressure.

While there was agreement that it was right to be concerned about the paclitaxel mortality signal raised by Konstantinos Katsanos (Patras, Greece) et al in their December 2018 meta-analysis, there was strong consensus that the evidence is now clear there is no mortality effect when paclitaxel is used in the peripheral arteries. In addition, it was noted that several individual patient-level meta-analyses failed to confirm the high mortality signal flagged by Katsanos and colleagues. There was some discussion surrounding the place of limus as an alternative to paclitaxel, but experts agreed that there is no need to move to another drug—which would have its own set of challenges—given the proven safety and efficacy of paclitaxel. The takeaway message was clear: that, with proper caution and the correct dose, paclitaxel can and should be used in peripheral interventions.

DLyte electropolishing can be used for finishing fragile parts with a wide range of applications from slight deburring to high gloss polishing as the media is non-abrasive and during the process, a high vibration is applied to reduce the friction between the media and the surface. Compared to the liquid electropolishing DLyte is easier to control as it is less aggressive treatment.

Under conditions of hypoxia, most eukaryotic cells can shift their primary metabolic strategy from predominantly mitochondrial respiration towards increased glycolysis to maintain ATP levels. This hypoxia-induced reprogramming of metabolism is key to satisfying cellular energetic requirements during acute hypoxic stress. At a transcriptional level, this metabolic switch can be regulated by several pathways including the hypoxia inducible factor-1α (HIF-1α) which induces an increased expression of glycolytic enzymes.

Endovascular treatment has become first line therapy for the treatment of femoropopliteal disease. Drug-coated devices play a key role in maintaining vessel patency. In the past antiproliferative coating of drug-coated balloons (DCBs) exclusively consisted of paclitaxel. Use of limus drugs was limited by a short residency time in the vessel wall.

The optimal treatment for patients with symptomatic severe intracranial atherosclerotic disease is not well established. Angioplasty and stenting have been attempted, with controversial results, mainly attributed to perioperative complications and a high incidence of restenosis or in-stent restenosis. Drug-coated balloons (DCBs) have shown encouraging results for coronary and peripheral artery disease, without convincing data for intracranial vasculature.

Endovascular treatment (EVT) for symptomatic ICAD treatment has been long debated since the first description of percutaneous transluminal angioplasty in a symptomatic basilar ICAD by Sundt et al in 1980.3 Since the negative SAMMPRIS and VISSIT trials,4 endovascular treatment of symptomatic ICAD—especially percutaneous transluminal angioplasty stenting—has been reluctantly used. Nevertheless, recent results from the WAEVE trial demonstrated a significantly lower periprocedural stroke and death rate of 2.9%,5 which encourages consideration of EVT for symptomatic intracranial atherosclerotic disease.

No specialty in the history of medicine has seen such rapid growth and innovation as interventional cardiology, due to a combination of the compelling need for better results in the treatment of coronary artery disease (CAD), the first cause of death worldwide, and the unique personality of remarkable individuals driving progress.