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Evaluation of Flow Diverter Stent Performance for Effective Cerebral Aneurysm Treatment

  • 전여진 (Yeo Jin Jun, 아주대학교 일반대학원)

초록/요약

Flow diverter (FD) represents a promising approach for managing wide necked intracranial aneurysms through modulation of hemodynamics within the aneurysm sac. Nonetheless, challenges persist in the procedural technique, often resulting in suboptimal deployment or placement. This investigation focuses on three variants of FDs with alterations in wire composition while maintaining identical structural design. Variations in physical characteristics such as pre- and post-deployment stent dimensions, radial force, and radiopacity were assessed. Utilizing a simulated model, the deployment performance and trackability force of these FDs were scrutinized. Additionally, the deployment behavior within a 3D printed aneurysm model was analyzed. The NiTi FD, comprising solely of nitinol (NiTi) wire, exhibited complete size recovery and 42% to 45% metal coverage post-loading, with low trackability force (10.9 to 22.9gf), facilitating smooth maneuverability within the delivery system. However, its limited X-ray visibility renders it unsuitable for clinical use. The NiTi-Pt/W FD, incorporating a blend of NiTi and Platinum/Tungsten (Pt/W) wires, demonstrated superior radiopacity and compression force (6.03±0.29 gf) but encountered elevated trackability force (22.4 to 39.9gf) and susceptibility to mesh loosening, complicating the procedure. The NiTi(Pt) FD, utilizing platinum-core nitinol (NiTi(Pt)) wire, exhibited comparable trackability force (11.3 to 22.1gf) to NiTi FD with uniform deployment, enhancing procedural ease, albeit with concerns regarding expansion force (1.79±0.30 gf) and potential migration. Since FDs are implanted in blood vessels, hemocompatibility is a critical performance characteristic. This study also explores hemocompatibility improvements through Phosphorylcholine (PC) coating, which is commercially accessible and easy to use. SEM/EDX analysis confirmed the PC coating on the FD specimen. The PC coated FD demonstrated improved antifouling effects in the flow test and enhanced hemocompatibility in both platelet adhesion and blood flow tests. This comparative analysis sheds light on how diverse wire materials impact FD performance, providing insights for clinicians and researchers to optimize FD selection and design for effective intracranial aneurysm treatment. Though preliminary, this study lays groundwork for future investigations in this domain. Keywords: flow diverter; nitinol; platinum core nitinol; stent; aneurysm treatment; trackability force; simulated model, phosphorylcholine, hemocompatibility, antifouling effect, platelet adhesion

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목차

I. Introduction 1
1. Cerebral aneurysm treatment 1
1.1. Cerebral aneurysm 1
1.2. Endovascular treatment 4
1.3. Cerebral Aneurysm treatment method 6
2. Flow diverter treatment 8
2.1. Flow diverter 8
2.2. Evaluation of new medical technology for cerebral aneurysm embolization using flow diverter (in Korea) 13
2.3. Problems in flow diverter procedures 13
2.4. Flow diverter wire materials 15
3. Phosphorylcholine coating for hemocompatibility 18
II. Experimental 21
1. Flow diverter preparation 21
2. Flow diverter physical properties analysis 21
2.1. Size variation 21
2.2. Radiopacity 22
2.3. Radial force 22
3. Flow diverter trackability & deployment analysis in artificial model 22
3.1. Trackability and deployment force 22
3.2. Flow diverter deployment in 3D printed ICA aneurysm model 25
4. Phosphorylcholine coating for hemocompatibility 26
4.1. Phosphorylcholine coating 26
4.2. Surface comparison before and after coating 26
4.2.1 SEM (Scanning Electron Microscope) 26
4.2.2 EDX (Energy Dispersive X-ray spectrometer) 27
4.2.3 Flow test 27
4.3. Comparison of hemocompatibility 27
4.3.1 Platelet adhesion 27
4.3.2 Blood flow test 28
5. Statistical analysis 28
III. Result and discussion 29
1. Flow diverter physical properties analysis 29
1.1. Diameter change before and after delivery loading 29
1.2. Cell area change before and after delivery loading 32
1.3. Radiopacity 35
1.4. Radial force 36
2. Flow diverter trackability & deployment analysis in artificial model 40
2.1. Trackability and deployment force 40
2.2. Flow diverter deployment in 3D printed ICA aneurysm model 44
3. Phosphorylcholine coating for hemocompatibility 47
3.1. Phosphorylcholine coating 48
3.2. Surface comparison before and after coating 48
3.2.1 SEM (Scanning Electron Microscope) 48
3.2.2 EDX (Energy Dispersive X-ray spectrometer) 49
3.2.3 Flow test 50
3.3. Comparison of hemocompatibility 51
3.3.1 Platelet adhesion 51
3.3.2 Blood flow test 52
IV. Conclusion 54
Ⅴ. References 57
Abstract in Korean 68

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