Occlusion of Experimental Aneurysms with Heparin-loaded, Microporous Stent Grafts

OBJECTIVEAn embolization technique using a stent graft has been developed to replace the conventional type of direct surgery or neurointervention with platinum coils and/or bare stents. The utility of a commercially available metal stent wrapped with a microporous elastomeric film coated with a thin, heparin-loaded, photocured gelatinous layer for the treatment of experimental carotid artery sidewall aneurysms in dogs was evaluated. METHODSThe stent graft was used for embolization of experimental carotid artery aneurysms in dogs. The aneurysms were prepared bilaterally in canine carotid arteries with branching of an external jugular vein patch. RESULTSThe entries into all of the aneurysms were occluded immediately after placement of the stent grafts, and the aneurysms were embolized by thrombus formation even 1 week after deployment. All of the parent carotid arteries in which stent grafts were placed were patent, without severe stenosis, immediately (n = 2), 1 week (n = 4), 1 month (n = 3), and 3 months (n = 4) after placement. Scanning electron microscopy demonstrated that the luminal surfaces of the stent grafts were entirely endothelialized as soon as 1 week after placement, via transmural tissue ingrowth through the micropores formed in the covering film. CONCLUSIONThe stent graft we have developed seems to be highly promising for the treatment of aneurysms, especially with respect to immediate termination of blood inflow for aneurysm occlusion and rapid endothelialization in the aneurysm neck.

[1]  Y. Nakayama,et al.  Surface microarchitectural design in biomedical applications: in vitro transmural endothelialization on microporous segmented polyurethane films fabricated using an excimer laser. , 1996, Journal of Biomedical Materials Research.

[2]  A. Algra,et al.  Treatment of intracranial aneurysms by embolization with coils: a systematic review. , 1999, Stroke.

[3]  G. Nesbit,et al.  Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience. , 1998, Neurosurgery.

[4]  G. Geremia,et al.  Occlusion of experimentally created fusiform aneurysms with porous metallic stents. , 2000, AJNR. American journal of neuroradiology.

[5]  Tony P. Smith,et al.  Delayed stenosis following placement of a polyethylene terephthalate endograft in the cervical carotid artery. Report of three cases. , 2003, Journal of neurosurgery.

[6]  E. Edelman,et al.  Tissue engineered perivascular endothelial cell implants regulate vascular injury. , 1995, Proceedings of the National Academy of Sciences of the United States of America.

[7]  W. Edwards,et al.  Polymeric stenting in the porcine coronary artery model: differential outcome of exogenous fibrin sleeves versus polyurethane-coated stents. , 1994, Journal of the American College of Cardiology.

[8]  J Haberstroh,et al.  Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms: an experimental study in a canine model. , 1994, AJNR. American journal of neuroradiology.

[9]  K. Tabuchi,et al.  [Histological findings in aneurysm treated with IDC: scanning electron microscopical study]. , 1997, No shinkei geka. Neurological surgery.

[10]  G. Geremia,et al.  Embolization of experimentally created aneurysms with intravascular stent devices. , 1992, AJNR. American journal of neuroradiology.

[11]  G. Duckwiler,et al.  Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. , 1997, Journal of neurosurgery.

[12]  C. Strother,et al.  Treatment of experimental canine carotid aneurysms with platinum coils. , 1993, AJNR. American journal of neuroradiology.

[13]  G. Duckwiler,et al.  Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. , 1991, Journal of neurosurgery.

[14]  S. Diamond,et al.  Topic review: surface modifications enhancing biological activity of guglielmi detachable coils in treating intracranial aneurysms. , 2000, Surgical neurology.

[15]  A. M. Cook,et al.  Case report: treatment of a carotid artery pseudoaneurism with a polyester covered nitinol stent. , 1995, Clinical radiology.

[16]  J. Palmaz,et al.  Intravascular stents: tissue-stent interactions and design considerations. , 1993, AJR. American journal of roentgenology.

[17]  F. Castañeda,et al.  Assessment of a polyester-covered nitinol stent in an atherosclerotic swine model. , 2000, Journal of vascular and interventional radiology : JVIR.

[18]  A. Motta,et al.  Polyurethane-coated, self-expandable biliary stent: an experimental study. , 1995, Academic radiology.

[19]  F. Sherman,et al.  Experimental evaluation of a tissue adhesive as an agent for the treatment of aneurysms and arteriovenous anomalies. , 1972, Journal of neurosurgery.

[20]  J. C. Smith,et al.  Interspecies healing of porous arterial prostheses: observations, 1960 to 1974. , 1974, Archives of surgery.

[21]  C. Cognard,et al.  [Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases]. , 1997, Journal of neuroradiology. Journal de neuroradiologie.

[22]  H Handa,et al.  Experimentally induced cerebral aneurysms in rats. , 1978, Surgical neurology.

[23]  H. Uehata,et al.  Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans. , 2000, Circulation.

[24]  C. Claussen,et al.  Covered stents for prevention of restenosis. Experimental and clinical results with different stent designs. , 1996, Investigative radiology.

[25]  V. Macellari,et al.  Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. , 1991, Journal of neurosurgery.

[26]  H. Plenk,et al.  Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils. , 1999, Journal of neurosurgery.

[27]  Michel E. Mawad,et al.  Guglielmi detachable coil embolization of acute intracranial aneurysm , 1997 .

[28]  Pertti Törmälä,et al.  Biodegradation of the Copolymeric Polylactide Stent , 2001, Journal of Vascular Research.

[29]  Y. Nakayama,et al.  Newly Developed Stent Graft with Micropored and Heparin Impregnated SPU Film , 2001, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[30]  W. Marston,et al.  Endovascular Repair of Peripheral Aneurysms, Pseudoaneurysms, and Arteriovenous Fistulas , 1997, Annals of vascular surgery.

[31]  James V. Byrne,et al.  Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding , 1999 .

[32]  H. Kikuchi,et al.  Experimental induction of cerebral aneurysms in monkeys. , 1987, Journal of neurosurgery.

[33]  R. Buschman,et al.  Experimental carotid aneurysms: I. Simple surgical production and radiographic evaluation. , 1977, Investigative radiology.

[34]  T. Bjornsson,et al.  Acidic fibroblast growth factor promotes vascular repair. , 1991, Proceedings of the National Academy of Sciences of the United States of America.

[35]  S M Schwartz,et al.  The intima. Soil for atherosclerosis and restenosis. , 1995, Circulation research.

[36]  W. J. German,et al.  Experimental production of carotid aneurysms. , 1954, The New England journal of medicine.

[37]  Y. Nakayama,et al.  Novel compliant and tissue-permeable microporous polyurethane vascular prosthesis fabricated using an excimer laser ablation technique. , 1996, Journal of biomedical materials research.

[38]  J. Isner,et al.  Local delivery of vascular endothelial growth factor accelerates reendothelialization and attenuates intimal hyperplasia in balloon-injured rat carotid artery. , 1995, Circulation.

[39]  A. Heisel,et al.  Coronary implantation of silicone-carbide-coated Palmaz-Schatz stents in patients with high risk of stent thrombosis without oral anticoagulation. , 1997, Catheterization and cardiovascular diagnosis.

[40]  A. Berlis,et al.  Poly-lactic-acid coating for endovascular stents. Preliminary results in canine experimental arteriovenous fistulae. , 1997, Investigative radiology.

[41]  G. Leclerc,et al.  Healing mechanisms in experimental aneurysms. I. Vascular smooth muscle cells and neointima formation. , 1999, Journal of neuroradiology. Journal de neuroradiologie.

[42]  K. Bailey,et al.  Differential neointimal response to coronary artery injury in pigs and dogs. Implications for restenosis models. , 1994, Arteriosclerosis and thrombosis : a journal of vascular biology.