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Original research
Phosphorylcholine surface modified flow diverter associated with reduced intimal hyperplasia
  1. Jildaz Caroff1,2,
  2. Takamitsu Tamura1,
  3. Robert M King1,
  4. Pedro N Lylyk1,
  5. Erin T Langan1,
  6. Olivia W Brooks1,
  7. Frédéric Clarençon3,
  8. John Michael Wainwright4,
  9. Laurent Spelle2,
  10. Miklos Marosfoi1,
  11. Matthew J Gounis1,
  12. Ajit S Puri1
  1. 1 New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2 Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
  3. 3 Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
  4. 4 Research and Development, Medtronic Neurovascular, Irvine, California, USA
  1. Correspondence to Dr Matthew J Gounis, New England Center for Stroke Research, University of Massachusetts, Worcester, MA 01655, USA; matt.gounis{at}


Background Optical coherence tomography (OCT) is a high-resolution, intra-vascular diagnostic technique widely used for the characterization of vascular pathologies and optimization of stent implantation during percutaneous coronary intervention. OCT was used to investigate the in vivo vascular response to a new phosphorylcholine surface modified flow diverter (sPED).

Methods In an in vivo rabbit aneurysmal model, we used two different types of flow diverters (classic Pipeline – cPED; and sPED) with or without dual antiplatelet therapy (four groups, n=10 per group). OCT cross-sectional area measurements were compared with histology in all animals. Neointimal hyperplasia (NIH) ratio was compared between OCT and histology at five different levels for each stent. The severity of NIH was also compared between the different stents, antiplatelet protocols, and vessel locations.

Results OCT was used to calculate in-stent hyperplasia in 227 different locations corresponding to histology sections. OCT measurement strongly correlated with gold standard histology (r2=0.83; slope=0.988; P<0.0001). sPED had significantly less in-stent NIH than non-treated flow diverters (mean percent of lumen reduction 5.7% for sPED versus 8.9% for cPED; P<0.0001). The NIH ratio was slightly higher with dual antiplatelet therapy (DAPT) (NIH ratio=7.9% with DAPT versus 6.8% without DAPT; P<0.05). Complete and near complete occlusion rates of the aneurysms were not different with the cPED or sPED.

Conclusion OCT is a promising technique for immediate and long-term evaluation of flow diverter stent treatments. In an animal model, phosphorylcholine surface modified flow diverters induces less NIH after stent implant without reducing aneurysm occlusion rates.

  • Intracranial aneurysm
  • flow diverter
  • optical coherence tomography

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  • JC, TT and RMK contributed equally.

  • Contributors Study design: JC, RMK, ETL, JMW, FC, MM, MJG, and ASP. Data acquisition: JC, TT, RMK, ETL, FC, MM. Literature research: JC, RMK, MM, MJG. Data analysis and interpretation: JC, TT, RMK, PNL, FC, LS, MM, MJG, and ASP. Manuscript preparation: JC and RMK. Revision of manuscript for important intellectual content: FC, MM, MJG, and ASP. Approval of final version of manuscript: all authors.

  • Funding This work was supported by Medtronic Neurovascular. The content is solely the responsibility of the authors, and does not represent the official views of Medtronic. JC was supported by research grants from the Fulbright Program, the Philippe Foundation, and the French Society of Radiology.

  • Competing interests FC: Has been a consultant on a fee-per-hour basis for Medtronic, Balt Extrusion, Guerbet (paid lectures), and for Codman Neurovascular (Study core lab). ETL: Has been a consultant on fee-per-hour basis for R92M, Stryker Neurovascular, and The Stroke Project. JMW: Is employed by Medtronic Neurovascular. LS: Has been a consultant on fee-per-hour basis for Medtronic Neurovascular, Microvention, Stryker Neurovascular. MJG: Has been a consultant on a fee-per-hour basis for Codman Neurovascular, InNeuroCo, Medtronic Neurovascular, R92 Medical, Stryker Neurovascular, and the Stroke Project; holds stock in InNeuroCo; and has received research support from the National Institutes of Health (NIH), Anaconda, Codman Neurovascular, Gentuity, InNeuroCo, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Neuravi, Philips Healthcare, InNeuroCo, Rapid Medical, R92M, Stryker Neurovascular, The Stroke Project, and the Wyss Institute. ASP: Has been a consultant on a fee-per-hour basis for Medtronic Neurovascular and Stryker Neurovascular; and has received research grants from Medtronic Neurovascular and Stryker Neurovascular. JC: Has received educational scholarships from Medtronic Neurovascular and Microvention/Terumo.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published online, a competing interest has been added for the author JC.

  • Presented at 14 Annual Meeting of the SNIS, Colorado Springs CO. July 26-28, 2017.