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Original research
In vitro flow diversion effect of the ReSolv stent with the shelf technique in a bifurcation aneurysm model
  1. Brooke L Belanger1,
  2. Rosalie Morrish1,
  3. Davis McClarty2,
  4. Colette Barnstable1,
  5. Warren Muir1,
  6. Soheil Ghazizadeh3,
  7. Muneer Eesa1,
  8. David Fiorella4,
  9. John H Wong1,
  10. Chandar Sadasivan4,
  11. Alim P Mitha1,3
  1. 1 Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
  2. 2 Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  3. 3 Department of Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  1. Correspondence to Dr Alim P Mitha, Clinical Neurosciences, Foothills Medical Centre, Calgary, Canada; amitha{at}ucalgary.ca

Abstract

Background Flow-diverting stents are not currently indicated for the treatment of bifurcation aneurysms, and some case series have demonstrated low occlusion rates, possibly due to a lack in neck coverage. The ReSolv stent is a unique hybrid metal/polymer stent that can be deployed with the shelf technique in order to improve neck coverage.

Methods A Pipeline, unshelfed ReSolv, and shelfed ReSolv stent were deployed in the left-sided branch of an idealized bifurcation aneurysm model. After determining stent porosity, high-speed digital subtraction angiography runs were acquired under pulsatile flow conditions. Time–density curves were created using two region of interest (ROI) paradigms (total aneurysm and left/right), and four parameters were extracted to characterize flow diversion performance.

Results The shelfed ReSolv stent demonstrated better aneurysm outflow alterations compared to the Pipeline and unshelfed ReSolv stent when using the total aneurysm as the ROI. On the left side of the aneurysm, there was no significant difference between the shelfed ReSolv stent and the Pipeline. On the right side of the aneurysm, however, the shelfed ReSolv stent had a significantly better contrast washout profile than the unshelfed ReSolv stent and the Pipeline stent.

Conclusions The ReSolv stent with the shelf technique demonstrates the potential to improve flow diversion outcomes for bifurcation aneurysms. Further in vivo testing will help to determine whether the additional neck coverage leads to better neointimal scaffolding and long-term aneurysm occlusion.

  • Aneurysm
  • Angiography
  • Flow Diverter
  • Stent

Data availability statement

Data are available upon reasonable request. Not Applicable.

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Data availability statement

Data are available upon reasonable request. Not Applicable.

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Footnotes

  • Contributors BLB, RM: conceptualized the study, performed experiments, collected and analyzed the data, performed statistical analysis, and drafted and revised the paper. DM: performed experiments, collected and analyzed the data, and revised the paper. CB, WM, SG: performed experiments and revised the paper. ME: conceptualized the study, performed experiments, collected and analyzed the data, and revised the paper. DF: conceptualized the study and revised the paper. JHW conceptualized the study, analyzed the data, and revised the paper. CS: conceptualized the study, collected and analyzed the data, performed statistical analysis, and drafted and revised the paper. APM: conceptualized the study, performed experiments, collected and analyzed the data, drafted and revised the paper, and acts as the guarantor. All authors agreed to be accountable for the accuracy and integrity of this manuscript.

  • Funding This work was funded in part by Fluid Biomed Inc, a MITACS grant, and a National Research Council of Canada Industrial Research Assistance Program (IRAP) grant. APM received financial support from the Evolve2Innovate (e2i) program at the University of Calgary. BLB was funded by NSERC Brain CREATE and the e2i program.

  • Competing interests DM and SG are employed by Fluid Biomed Inc. ME is a shareholder of Fluid Biomed Inc. DF is on the editorial board of the Journal of NeuroInterventional Surgery; has received consulting, proctoring, and/or research support from Balt USA, MicroVention, Prenumbra, and Stryker; and is a shareholder of Marblehead, Mentice Inc, Neurogami Medical Inc., NV Med, and Scientia Medical. JHW is a co-founder and shareholder of Fluid Biomed Inc, and holds patents related to the technology described in this manuscript. CS has received consulting, proctoring, and/or research support from Stryker Neurovascular, Medtronic Neurovascular, Rapid Medical, Balt USA, Siemens Healthineers, and Mentice Inc. APM received research support from Evolve2Innovate, Fluid Biomedical, and Stryker Neurovascular; is a consultant for Cerus Endovascular; is a co-founder and shareholder of Fluid Biomed Inc; and holds patents related to the technology described in this manuscript.

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