Longitudinal healing flow diverting stents with phosphorylcholine surface modification

BackgroundFlow diversion has become a standard treatment for cerebral aneurysms. However, major drawbacks include the need for dual antiplatelet therapy after implant and delayed complete occlusion of the aneurysm, which occurs when new tissue growth excludes the aneurysm from the parent artery. Biomimetic surface modifications such as the phosphorylcholine polymer (Shield surface modification) represent major advances in reducing thrombogenicity of these devices. However, in vitro studies have raised concerns that this modification may also delay endothelialization of flow diverters. MethodsBare metal Pipeline, Pipeline Shield, and Vantage with Shield devices were implanted in the common carotid arteries (CCAs) of 10 rabbits (two in the left CCA, one in the right CCA). Following implant and at 5, 10, 15, and 30 days, the devices were imaged with high-frequency optical coherence tomography and conventional angiography to evaluate tissue growth. At 30 days the devices were explanted and their endothelial growth was assessed with scanning electron microscopy (SEM) at five locations along their length using a semi-quantitative score. ResultsThe average tissue growth thickness (ATGT) was not different between the three devices. Neointima was apparent at 5 days and all devices demonstrated similar ATGT at each time point. On SEM, no difference was found in the endothelium scores between the device types. ConclusionIn vivo, neither the Shield surface modification nor the device design (Vantage) altered the longitudinal healing of the flow diverter.

Automated summary

Flow diversion is a common treatment for cerebral aneurysms, but it has drawbacks such as the need for dual antiplatelet therapy and delayed complete occlusion of the aneurysm. Biomimetic surface modifications have been developed to reduce thrombogenicity, but there are concerns about delayed endothelialization. In this study, the in vivo performance of flow diverters with different surface modifications was evaluated in rabbit models.