Multicenter study of the safety and effectiveness of intracranial aneurysm treatment with the p64MW-HPC flow modulation device.

BACKGROUND AND PURPOSE: The new p64 flow diverter with hydrophilic polymer coating (HPC) was designed to reduce thrombogenicity. To date, it is unclear how antithrombogenic surface modifications affect neoendothelialization and thrombus formation in patients with unruptured intracranial aneurysms. The purpose of this study was to evaluate the safety and effectiveness of the p64MW-HPC in the treatment of unruptured aneurysms of small to giant size and of both the anterior and posterior circulation. MATERIALS AND METHODS: Between March 2020 and October 2022 all patients with unruptured intracranial aneurysms treated with the p64MW-HPC were included at five neurovascular centers. Demographic data, aneurysm characteristics, antiplatelet therapy, procedural complications, and clinical and angiographic outcomes were recorded. RESULTS: A total of 100 patients with 100 unruptured intracranial aneurysms met the inclusion criteria. Eighty-three aneurysms were classified as saccular, 12 aneurysms were fusiform, 4 aneurysms dissecting, and 1 aneurysm was blister-like. Dual antiplatelet therapy with Clopidogrel and Aspirin was given in 68 cases, and with Ticagrelor and Aspirin in 24 cases. Technical issues with deployment were encountered in 14 cases (torsion (n = 3), foreshortening (n = 8), and incomplete opening (n = 3)). Ischemic stroke occurred in a total of seven cases. In one patient a wire perforation and subsequent severe ICH occurred. Complete aneurysm occlusion at angiographic follow-up (mean time = 7 months) was seen in 73% and adequate occlusion in 93%. CONCLUSION: This study is the largest multicenter study to date documenting the safety and effectiveness of the new antithrombogenic p64MW-HPC in the treatment of unruptured intracranial aneurysms of the anterior and posterior circulation.

Aneurysm Treatment in Acute SAH with Hydrophilic-Coated Flow Diverters under Single-Antiplatelet Therapy: A 3-Center Experience.

BACKGROUND AND PURPOSE: In certain clinical circumstances, dual-antiplatelet therapy can be problematic in patients with acute SAH. In some aneurysms, however, flow-diverting stents are the ideal therapeutic option. We report our experience with ruptured intracranial aneurysms treated with flow diverters with hydrophilic coating (p48 MW HPC and p64 MW HPC) under single-antiplatelet therapy. MATERIALS AND METHODS: Patients were treated with either flow-diverter placement alone or a flow diverter and additional coiling. Due to the severity of the hemorrhage, the potential for periprocedural rehemorrhage, and the potential for additional surgical interventions, a single-antiplatelet regimen was used in all patients. RESULTS: Thirteen aneurysms were treated in 10 patients. The median age was 62 years; 5 patients were male. All had acute SAH due to aneurysm rupture. Four blood-blister, 2 dissecting, and 7 berrylike aneurysms were treated. Seven aneurysms were adjunctively coiled. Eight of the 10 patients received a single-antiplatelet protocol of aspirin, 1 patient was treated with prasugrel only, and 1 patient was treated with tirofiban first and then switched to the aspirin single-antiplatelet protocol. One device-related complication occurred, a thrombosis of an overstented branch. All stents, however, remained open at DSA, CTA, or MRA follow-up. CONCLUSIONS: The implantation of flow diverters with reduced thrombogenicity due to hydrophilic surface coating under single-antiplatelet therapy seems to be an option in carefully selected cases of SAH due to aneurysm rupture.

Vessel Wall Enhancement in Unruptured Intracranial Aneurysms: An Indicator for Higher Risk of Rupture? High-Resolution MR Imaging and Correlated Histologic Findings.

BACKGROUND AND PURPOSE: Recent studies have suggested that wall enhancement of unruptured intracranial aneurysms in high-resolution MR imaging might serve as an imaging biomarker for higher risk of rupture. Histologic studies have revealed a possible association among inflammatory processes, degeneration, and destabilization of the aneurysm wall preceding rupture. Understanding the histologic condition underlying aneurysm wall enhancement could be an important step toward assessing the value of this method for risk stratification. We present our observations of aneurysm wall enhancement in MR vessel wall imaging and underlying histologic changes. MATERIALS AND METHODS: We reviewed records of patients with an unruptured middle cerebral artery aneurysm who underwent MR vessel wall imaging before aneurysm clipping. Contrast enhancement of the aneurysm wall was dichotomized into either none/faint or strong. Histologic analysis included myeloperoxidase stain for detection of inflammatory cell invasion and CD34 stain for assessment of neovascularization and vasa vasorum. RESULTS: Thirteen aneurysms were included. Five aneurysms showed strong wall enhancement. Among these, myeloperoxidase staining revealed inflammatory cell infiltration in 4. Three showed neovascularization. In 2 aneurysms, vasa vasorum were present. Seven aneurysms did not show wall enhancement; 1 had only mild enhancement. None of these bore evidence of inflammatory cell invasion or neovascularization, and they all lacked vasa vasorum. CONCLUSIONS: Wall enhancement in MR vessel wall imaging is associated with inflammatory cell invasion, neovascularization, and the presence of vasa vasorum. Enhancement does not occur when histologic signs of inflammation are absent. Our results support the hypothesis that MR vessel wall imaging could provide valuable information for risk stratification.

Planar system for magnetic induction conductivity measurement using a sensor matrix.

In this study the performance of an axial gradiometer sensor for magnetic induction tomography was investigated and the results of measurements to determine the precision and sensitivity of the sensor were undertaken. In the first part of the study a single gradiometer sensor was used and the noise and drift were measured for two excitation current values at a single frequency of 600 kHz. The variations of the real and imaginary received signal components with conductivity were then obtained for samples with 0-5 S m(-1). Both sets of measurements were repeated using two different forms of capacitive shielding. In the second part of the study the results of preliminary measurements obtained with a 2 x 2 planar matrix of axial gradiometers are given. The results of a simulation of a similar matrix using a commercial electromagnetic field calculation programme are also presented for comparison. For the sample utilized, the sensor output showed a linear variation with conductivity for the imaginary component of 0.033 mV S(-1) m using an excitation current of 316 mA at 600 kHz. No apparent correlation with conductivity for the real component was observed. The noise and drift of the imaginary component of the sensor output were 0.001 mV and 0.006 mV respectively, for the same excitation current. The results of the planar matrix measurements and simulations suggest that significant sensitivity is provided by using the measurement coils of the adjacent sensors. The measurement results however suggest that large improvements in the sensor noise and drift performance are required for these data to be of use.

Calculation of the dielectric properties of biological tissue using simple models of cell patches.

The measurement of the dielectric properties of biological tissue is of increasing scientific relevance. Models for the comprehension of the dielectric properties at various frequencies have been successfully set up. However, students often have problems in understanding the effects taking place on cellular level which lead to the observed dispersion. A numerical model of a biological tissue brick composed of single cells (micron-dimensions) between two plate electrodes is presented in this study. An electrical current in a range of 1 Hz to 3 GHz was applied to the electrodes and hence to the tissue model. Using an equivalent series circuit of a resistor and a capacitor it is possible to calculate the effective equivalent dielectric properties of the whole tissue model. The results show an increasing conductivity and decreasing permittivity with increasing frequency. This corresponds to experimental results obtained with different biological tissues.

Simulation of non-contact measurement of the electrical impedance using an anatomical model.

The measurement of the impedance of biological tissue can be a non-invasive method to find new data of diagnostic relevance. A system for a non-contact measurement of the electrical impedance of biological tissue is presented. The system consists of an excitation coil and two sensing coils, an upper and a lower coil. If the two sensing coils are coupled it can be used as a gradiometer coil. Numerical experiments with focus on the eddy currents in the tissue and on the detection of the small changes of the signal are carried out to calculate the fields, eddy current distributions and induced voltages. Hereby tests with different frequencies of the excitation current and different conductivities of a tissue block are used. Then the homogeneous tissue block is replaced with a fraction of the arm of an anatomical model which contains different tissue classes.

Design of a system for contact-free measurement of the conductivity of biological tissue.

The electrical impedance of tissue can give important informations about the viability of the tissue. A non-invasive and contact-free measuring system using an inductive sensor is presented. Using a single pick-up coil the system is not sensitive enough for measuring the small changes in conductivity of biological tissue. Employing a gradiometer instead of a single pick-up coil can improve the resolution of the system. The developed data acquisition system is realized using four parts: A lock-in-amplifier, providing a sinusoidal signal and measuring the signal of the sensor, a power amplifier, driving the excitation coil of the sensor, the inductive sensor and a preamplifier for buffering a reference signal and amplifying the output signal of the sensor. In this paper the focus is on the hardware that was set up. Results of measurements on inhomogeneous phantoms are shown.