Background and Purpose The safety and efficacy profile of flow diverter treatment for intracranial aneurysms has been well-established. However, predictors of successful flow diversion remain poorly characterized. Failed flow diversion attempts burden the healthcare system and put patients at risk due to long-term antiplatelet treatment and potential periprocedural complications. Fibrinogen deposition represents an integral component of intraaneurysmal thrombus formation. Therefore, we aimed to develop a preclinical testing platform utilizing fibrinogen to predict the in vivo performance of flow diverters.

Methods A flow diverter (4.75 x 20 mm) was deployed in the glass model of a saccular paraophthalmic segment aneurysm (4x4x4 mm). A human fibrinogen solution (Fibryga, Octopharma, Paramus, NJ) was circulated through the glass model using a peristaltic pump in triplicates. Thrombin, heparin, and calcium chloride were added to the fibrinogen solution, and physiologic blood concentrations were mimicked for all ingredients except heparin. The test fluid temperature was stabilized at 37°C with a heating bath. Complete aneurysm neck coverage time was recorded for varying flow rates (3, 4, and 5 cc/sec) with or without heparin or calcium chloride addition.

Results Fibrinogen specifically aggregated at the flow diverter’s aneurysm neck portion (100%, 6/6), while other segments of the flow diverter remained patent. Fibrinogen aggregation occurred without platelet aggregation or activation of other coagulation factors. The time to complete neck coverage varied between 15 (figure 1) and 24 minutes for different flow rates, with a higher flow rate achieving faster neck coverage. The model was sensitive to thrombin, heparin, and calcium chloride concentrations (table 1). With physiological concentrations and flow rate, the flow diverter’s portion at the aneurysm neck was completely covered in 20 minutes.

Conclusions Our preliminary study supports the potential of fibrinogen-based benchtop flow model as an effective tool for predicting flow diverter’s in vivo performance. In our study, fibrinogen-based flow model successfully reflected the changes in flow rates and concentrations of main procoagulants. Further research is needed to validate the utility of fibrinogen-based models in predicting flow diverter’s performance in patients.

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Abstract E-210 Figure 1

Disclosures C. Bilgin: None. A. Oliver: None. S. Arul: None. Y. Senol: None. D. Ericson: None. J. Cebral: None. D. Kallmes: None. R. Kadirvel: None.