Background High frequency optical coherence tomography (HF-OCT) is a novel intravascular imaging technology developed for use in the cerebral vasculature. We hypothesize that HF-OCT characterization of intrasaccular device neck coverage can prognosticate exclusion of the aneurysm from the circulation.
Methods Bifurcation and sidewall aneurysms were made in six dogs. Seven aneurysms were treated with next generation intrasaccular devices (NGID) and four with traditional platinum coils. HF-OCT was performed to interrogate gaps in the neck coverage, coil herniation, or acute thrombus formation. Animals were re-imaged at 7, 30, 90, and 180 days following aneurysm embolization. An automated image processing method segmented the devices at the neck of the aneurysm and quantified neck coverage. The largest coverage gap was used to predict aneurysm occlusion at 180 days.
Results No difference was found in occlusion rates between the coil and NGID groups (P=0.45). Successful segmentation of the NGID construct was achieved in all cases. A coverage gap >1 mm2 was found to predict failed aneurysm occlusion (P=0.047). This threshold was able to predict all cases of failed occlusion. The average number of devices needed to treat the aneurysm was lower in the NGID group (1.9 vs 6.75, P=0.009). HF-OCT showed strong agreement with scanning electron microscopy (bias 0.0024 mm2 (95% CI −0.0279, 0.0327)).
Conclusions HF-OCT enables precise and accurate measurement of coverage gaps at the neck of aneurysms treated with intrasaccular devices in vivo. We provide in vivo evidence that uniform aneurysm neck coverage by intrasaccular devices is critical for aneurysm occlusion.
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Contributors RMK: performed the experiments, analyzed and interpreted the data, wrote the manuscript, and approved the final manuscript. MM: performed the experiments, interpreted the data, revised the manuscript, and approved the final manuscript. JC: performed the experiments, analyzed and interpreted the data, and approved the final manuscript. GJU: performed the experiments, interpreted the data, revised the manuscript, and approved the final manuscript. DMG: performed the experiments and approved the final manuscript. MJG: designed the study, designed and performed the experiments, analyzed and interpreted the data, drafted the manuscript, approved the final manuscript, and agrees to be accountable for the accuracy and integrity of the work. ASP: designed the study, interpreted the data, revised the manuscript, and approved the final manuscript.
Funding Partially supported by research funding from Medtronic Neurovascular. JC was supported by research grants from the Fulbright Program, the Philippe Foundation and the French Society of Radiology (SFR-CERF). The content is solely the responsibility of the authors and does not reflect the opinions of the funding sources.
Competing interests MM: fee for service consulting for Stryker Neurovascular and InNeuroCo Inc. JC has received educational scholarships from Medtronic Neurovascular and Microvention/Terumo. GJU is an employee of Gentuity LLC and holds stock in Gentuity LLC. ASP: consultant for Medtronic Neurovascular and Stryker Neurovascular; and research grants from Medtronic Neurovascular and Stryker Neurovascular. MJG has been a consultant on a fee per hour basis for Cerenovus, Imperative Care, MIVI Neurosciences, Phenox, Route 92 Medical, and Stryker Neurovascular; holds stock in Imperative Care and Neurogami; and has received research support from the National Institutes of Health (NIH), the United States–Israel Binational Science Foundation, Anaconda, Cerenovus, Cook Medical, Gentuity, Imperative Care, InNeuroCo, Magneto, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Neuravi, Neurogami, Philips Healthcare, Rapid Medical, Route 92 Medical, Stryker Neurovascular, Syntheon, and the Wyss Institute.
Ethics approval All animal research procedures were approved by the university’s institutional animal care and use committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data presented in manuscript.
Patient consent for publication Not required.
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