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Original research
Communicating malapposition of flow diverters assessed with optical coherence tomography correlates with delayed aneurysm occlusion
  1. Robert M King1,
  2. Olivia W Brooks1,
  3. Erin T Langan1,
  4. Jildaz Caroff1,2,
  5. Frédéric Clarençon3,
  6. Takamitsu Tamura1,
  7. John Michael Wainwright4,
  8. Matthew J Gounis1,
  9. Miklós Marosfői1,
  10. Ajit S Puri1
  1. 1Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2Department of Interventional Neuroradiology, Bicêtre Hospital, Paris, France
  3. 3Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
  4. 4Research and Development, Medtronic Neurovascular, Irvine, California, USA
  1. Correspondence to Dr Matthew J Gounis, Department of Radiology Director, New England Center for Stroke Research, University of Massachusetts, Worcester, MA 01655, USA; matthew.gounis{at}


Background Optical coherence tomography (OCT) is a high resolution intravascular imaging method that allows visualization of flow diverter struts and the vessel wall. In this study, malapposition of the flow diverter that continues into the neck of the aneurysm, named communicating malapposition (CM), was investigated as a potential factor for delayed aneurysm healing.

Methods 40 New Zealand White rabbits underwent elastase induced aneurysm creation, and were subsequently assigned to one of four treatment groups based on flow diverter type and administration of antiplatelet therapy. All animals underwent post device deployment balloon angioplasty and subsequent OCT to assess device/vessel apposition. The incidence of CM seen on OCT was assessed with a binary scoring system: 0–CM present; 1–CM absent. At 30 days, DSA was acquired to assess aneurysm healing. Aneurysm healing on terminal DSA was measured using a previously developed 5 point scale, with a score of 3 or 4 considered a positive outcome.

Results All animals were grouped into a single cohort for analysis as no difference in the rate of CM or healing was seen in the four treatment groups. Significant interaction between the absence of CM and a positive outcome was confirmed by Fisher exact test (P=0.0034). Angioplasty was shown to treat 33% of the cases of CM seen at implant, and these treated cases overwhelmingly had a positive outcome (P<0.001).

Conclusion The use of OCT to assess CM of flow diverters has been shown to be predictive of the 30 day healing rate of an animal model of aneurysms.

  • aneurysm
  • device
  • flow diverter

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  • This paper was presented previously at the 14th Annual Meeting of the SNIS, Colorado Springs, Colorado, USA, on 26–28 July 2017 and at the WFITN, Budapest, Hungary, on 16–19 October 2017.

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

  • Competing interests JC has received educational scholarships from Medtronic Neurovascular and Microvention/Terumo. JMW is employed by Medtronic Neurovascular. MJG has been a consultant on a fee-per-hour basis for Codman Neurovascular, InNeuroCo, Medtronic Neurovascular, and Stryker Neurovascular; 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.

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

  • Data sharing statement Data queries for raw data (images, etc) can be made to the corresponding author.