The Pipeline Versus Telescoping Stents: In Vitro Flows in a Treated Cerebral Aneurysm Model

2012 ◽  
Author(s):  
Breigh N. Roszelle ◽  
M. Haithem Babiker ◽  
Justin Ryan ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
World Population ◽  
High Porosity ◽  
Recurrence Rates ◽  
Interventional Devices ◽  
Aneurysm Occlusion ◽  
Basilar Tip Aneurysm ◽  
Aneurysm Model ◽  
Low Porosity

Cerebral aneurysms are a significant concern; they are found in 2% of the world population [1]. While endovascular treatments have become a successful option for patients with cerebral aneurysms, recurrence rates remain as high as 50% [2]. Accordingly, many interventional devices are being developed with the hope of increasing the success rate of endovascular aneurysm occlusion. One of these devices is the low-porosity Pipeline emboilzation device (PED). Compared to more traditional intracranial stents, the PED contains a higher ratio of metal to surface area. Previously, similar reductions in porosity were obtained by sequentially deploying multiple high-porosity stents inside of one another, which is known as “telescoping.” The hemodynamic effects of using a single low-porosity device, versus telescoped high-porosity stents, have not been investigated thoroughly. In this study flow was quantified for idealized and anatomical basilar tip aneurysm models. The models were treated with sequentially placed high-porosity stents and a single low-porosity PED.

A Hybrid Coil/Polymer Device for Occlusion of Cerebral Aneurysms

2009 ◽  
Vol 3 (4) ◽  
Author(s):  
Fangmin Xu ◽  
Kevin Hart ◽  
Claire E. Flanagan ◽  
John C. Nacker ◽  
Roham Moftakhar ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
In Vitro Models ◽  
In Vivo Studies ◽  
Polymer Shell ◽  
Device Implantation ◽  
Occlusion Device ◽  
Aneurysm Occlusion ◽  
Aneurysm Model

The treatment of cerebral aneurysms is frequently accomplished via endovascular delivery of metal coils in order to occlude the aneurysm and prevent rupture. This procedure involves imprecise packing of large lengths of wire into the aneurysm and often results in high rates of aneurysm recanalization. Over time, this incomplete aneurysm occlusion can lead to aneurysm enlargement, which may have fatal consequences. This report describes the fabrication and preliminary testing of a novel aneurysm occlusion device composed of a single metal coil surrounded by a biocompatible polymer shell. These coil-in-shell devices were tested under flow conditions in synthetic in vitro models of saccular aneurysms and deployed in vivo in a short-term porcine aneurysm model to study occlusion efficacy. A single nickel titanium shape memory wire was used to deploy a biocompatible, elastic polymeric shell, leading to aneurysmal sac filling in both in vitro and in vivo aneurysm models. The deployment of this coil-in-shell device in synthetic aneurysm models in vitro resulted in varying degrees of aneurysm occlusion, with less than 2% of trials resulting in significant leakage of fluid into the aneurysm. Meanwhile, in vivo coil-in-shell device implantation in a porcine aneurysm model provided proof-of-concept for successful occlusion, as both aneurysms were completely occluded by the devices. Both in vitro and in vivo studies demonstrated that this coil-in-shell device may be attractive as an alternative to traditional coil embolization methods in some cases, allowing for a more precise and controlled aneurysm occlusion.

Comparison Among Different High Porosity Stent Configurations: Hemodynamic Effects of Treatment in a Large Cerebral Aneurysm

2014 ◽  
Vol 136 (2) ◽  
Author(s):  
Breigh N. Roszelle ◽  
Priya Nair ◽  
L. Fernando Gonzalez ◽  
M. Haithem Babiker ◽  
Justin Ryan ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Simulation ◽  
Cerebral Aneurysms ◽  
Post Treatment ◽  
Patient Specific ◽  
High Porosity ◽  
Velocity Magnitude ◽  
Large Patient ◽  
Aneurysm Model

Whether treated surgically or with endovascular techniques, large and giant cerebral aneurysms are particularly difficult to treat. Nevertheless, high porosity stents can be used to accomplish stent-assisted coiling and even standalone stent-based treatments that have been shown to improve the occlusion of such aneurysms. Further, stent assisted coiling can reduce the incidence of complications that sometimes result from embolic coiling (e.g., neck remnants and thromboembolism). However, in treating cerebral aneurysms at bifurcation termini, it remains unclear which configuration of high porosity stents will result in the most advantageous hemodynamic environment. The goal of this study was to compare how three different stent configurations affected fluid dynamics in a large patient-specific aneurysm model. Three common stent configurations were deployed into the model: a half-Y, a full-Y, and a crossbar configuration. Particle image velocimetry was used to examine post-treatment flow patterns and quantify root-mean-squared velocity magnitude (VRMS) within the aneurysmal sac. While each configuration did reduce VRMS within the aneurysm, the full-Y configuration resulted in the greatest reduction across all flow conditions (an average of 56% with respect to the untreated case). The experimental results agreed well with clinical follow up after treatment with the full-Y configuration; there was evidence of thrombosis within the sac from the stents alone before coil embolization was performed. A computational simulation of the full-Y configuration aligned well with the experimental and in vivo findings, indicating potential for clinically useful prediction of post-treatment hemodynamics. This study found that applying different stent configurations resulted in considerably different fluid dynamics in an anatomically accurate aneurysm model and that the full-Y configuration performed best. The study indicates that knowledge of how stent configurations will affect post-treatment hemodynamics could be important in interventional planning and demonstrates the capability for such planning based on novel computational tools.

Computational Analyses of an In-Vitro Aneurysm Model Based on Three-Dimensional Angiography With Comparison to Phase Contrast Magnetic Resonance Imaging and Dye Injection Studies

2010 ◽  
Author(s):  
Stephanie M. George ◽  
Pierre Watson ◽  
John N. Oshinski ◽  
Charles W. Kerber ◽  
Daniel Karolyi ◽  
...  
Keyword(s):  
High Speed ◽  
Phase Contrast ◽  
Cfd Simulation ◽  
Fluid Dynamic ◽  
Three Dimensional ◽  
Cerebral Aneurysms ◽  
Computational Fluid Dynamic Simulation ◽  
Poor Correlation ◽  
Aneurysm Model

Computational fluid dynamic simulation (CFD) is a valuable tool that has been used to understand some of the fundamental conditions of cerebrovascular flow. Current methods include anatomic modeling of cerebral aneurysms derived from vascular imaging such as MRA, CTA, and three-dimensional angiography. The input blood flow waveforms can be represented from either mathematical models or physiologic sampling of flow with phase contrast MR techniques or particle image velocimetry (1). While there has been general acceptance of the validity of computational fluid dynamics, some research suggests that there can be poor correlation between CFD flow calculations and directly measured flow (2). Therefore, the purpose of this study is to qualitatively compare flow patterns in a cerebral aneurysm model using data derived from three sources: (i) direct phase contrast MRA measurement in the model; (ii) CFD simulation using computer models created from three dimensional angiography, and (iii) previously published high speed injection dye studies.

scholarly journals Two- to five-year follow-up of 78 patients after treatment with the Flow Redirection Endoluminal Device

2019 ◽  
Vol 26 (1) ◽  
pp. 38-44 ◽  
Author(s):  
Hannes Luecking ◽  
Arnd Doerfler ◽  
Philipp Goelitz ◽  
Philip Hoelter ◽  
Tobias Engelhorn ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Recurrence Rates ◽  
Distal Internal Carotid Artery ◽  
Aneurysm Growth ◽  
Aneurysm Occlusion ◽  
One Year ◽  
Related Mortality

Background and purpose Flow-diverter stents are well-established for the treatment of cerebral aneurysms. Flow Redirection Endoluminal Device differs from other flow-diverter stents by its dual-layer design and has proved equality to other devices in numerous short-term surveys. However, follow-up data covering substantially more than one year are still limited for this device. We present our long-term experience with Flow Redirection Endoluminal Device. Materials and methods Seventy-eight patients harboring distal internal carotid artery (91%) or vertebrobasilar (9%) cerebral aneurysms treated with Flow Redirection Endoluminal Device with or without adjunctive coiling met the inclusion criteria. All cases were evaluated for aneurysm occlusion (according to Modified Raymond Roy Classification, MRRC), for flow-diverter stents patency and configuration and for procedure- and device-related morbidity and mortality. Results Mean follow-up interval was 36.9 ± 9.5 months (<30 months: n = 18; 31–42 months: n = 31; >42 months: n = 24). Total and subtotal aneurysm occlusion after six months was assessed in 92.0% (MRRC1 = 77.3%, MRRC2 = 14.7%, MRRC3a =2.7%, MRRC3b = 4.1%) and increased to 95.9% (MRRC1 = 90.5%, MRRC2 = 5.4%, MRRC3a = 2.7%). There was one case of aneurysm growth requiring early re-treatment. Procedure-related morbidity was observed in three cases (3.8%; one transient hemiparesis, one suspected foreign-body reaction, and one micro-wire perforation). There was no procedure- or device-related mortality. In-stent stenosis due to intimal hyperplasia was observed in two cases and fish-mouthing in three cases. Conclusions Our long-term data covering two to five years after flow diversion confirm that Flow Redirection Endoluminal Device is a safe and effective device for the treatment of cerebral aneurysms with progressive high aneurysm occlusion rates; recurrence rates were very low. Overall device-related morbidity was low and was not observed later than six months after intervention.

Aneurysm recurrence following endovascular balloon occlusion

1992 ◽  
Vol 77 (2) ◽  
pp. 260-264 ◽  
Author(s):  
Carl B. Heilman ◽  
Eddie S. K. Kwan ◽  
Julian K. Wu
Keyword(s):  
Cerebral Aneurysms ◽  
Balloon Occlusion ◽  
Fibrotic Response ◽  
Content Type ◽  
Bifurcation Aneurysm ◽  
Aneurysm Occlusion ◽  
Silicone Balloon ◽  
Endovascular Balloon Occlusion ◽  
Aneurysm Model

✓ Endovascular balloon occlusion is an alternative treatment for surgically unclippable cerebral aneurysms. The results of aneurysm occlusion with either a silicone or a latex balloon in a common carotid artery bifurcation aneurysm model are compared to determine which type of balloon was least likely to result in aneurysm recurrence. Five rabbits each underwent endovascular balloon occlusion with either a silicone or a latex balloon, with seven rabbits serving as controls. At 3 months postocclusion, nine of the 10 balloon-treated aneurysms had recurred. The recurrent aneurysm tended to be larger in animals treated with silicone than with latex balloons. A dense fibrotic response was present around the collar of the latex balloons, but no significant fibrotic response was found in the silicone balloon group. This study suggests that with currently available balloons, the initial complete angiographic obliteration of an aneurysm following balloon occlusion should not be interpreted as a cure and that periodic follow-up angiography should be performed.

Synthesis and In Vitro Enzymatic Studies of New 3-Aryldiazenyl Indoles as Promising Helicobacter pylori IMPDH Inhibitors

2019 ◽  
Vol 19 (5) ◽  
pp. 376-382 ◽  
Author(s):  
Sachin Jangra ◽  
Gayathri Purushothaman ◽  
Kapil Juvale ◽  
Srimadhavi Ravi ◽  
Aishwarya Menon ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Bacterial Infections ◽  
Immunosuppressive Drugs ◽  
Multi Drug Resistance ◽  
Metabolic Enzyme ◽  
World Population ◽  
Inhibitor Molecule ◽  
Nucleotide Synthesis ◽  
H Pylori

Background & Objective:Helicobacter pylori infection is one of the primary causes of peptic ulcer followed by gastric cancer in the world population. Due to increased occurrences of multi-drug resistance to the currently available antibiotics, there is an urgent need for a new class of drugs against H. pylori. Inosine 5′-monophosphate dehydrogenase (IMPDH), a metabolic enzyme plays a significant role in cell proliferation and cell growth. It catalyses guanine nucleotide synthesis. IMPDH enzyme has been exploited as a target for antiviral, anticancer and immunosuppressive drugs. Recently, bacterial IMPDH has been studied as a potential target for treating bacterial infections. Differences in the structural and kinetic parameters of the eukaryotic and prokaryotic IMPDH make it possible to target bacterial enzyme selectively.Methods:In the current work, we have synthesised and studied the effect of substituted 3-aryldiazenyl indoles on Helicobacter pylori IMPDH (HpIMPDH) activity. The synthesised molecules were examined for their inhibitory potential against recombinant HpIMPDH.Results:In this study, compounds 1 and 2 were found to be the most potent inhibitors amongst the database with IC50 of 0.8 ± 0.02µM and 1 ± 0.03 µM, respectively.Conclusion:When compared to the most potent known HpIMPDH inhibitor molecule C91, 1 was only four-fold less potent and can be a good lead for further development of selective and potent inhibitors of HpIMPDH.

scholarly journals Multi-Analytical Framework to Assess the In Vitro Swallowability of Solid Oral Dosage Forms Targeting Patient Acceptability and Adherence

Pharmaceutics ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 411
Author(s):  
Abdul Latif Ershad ◽  
Ali Rajabi-Siahboomi ◽  
Shahrzad Missaghi ◽  
Daniel Kirby ◽  
Afzal Rahman Mohammed
Keyword(s):  
Hydroxypropyl Methylcellulose ◽  
Analytical Framework ◽  
Dosage Forms ◽  
Oral Dosage ◽  
Surface Erosion ◽  
World Population ◽  
Swallowing Problems ◽  
Solid Oral Dosage Forms ◽  
Oral Dosage Forms

A lack of effective intervention in addressing patient non-adherence and the acceptability of solid oral dosage forms combined with the clinical consequences of swallowing problems in an ageing world population highlight the need for developing methods to study the swallowability of tablets. Due to the absence of suitable techniques, this study developed various in vitro analytical tools to assess physical properties governing the swallowing process of tablets by mimicking static and dynamic stages of time-independent oral transitioning events. Non-anatomical models with oral mucosa-mimicking surfaces were developed to assess the swallowability of tablets; an SLA 3D printed in vitro oral apparatus derived the coefficient of sliding friction and a friction sledge for a modified tensometer measured the shear adhesion profile. Film coat hydration and in vitro wettability was evaluated using a high-speed recording camera that provided quantitative measurements of micro-thickness changes, simulating static in vivo tablet–mucosa oral processing stages with artificial saliva. In order to ascertain the discriminatory power and validate the multianalytical framework, a range of commonly available tablet coating solutions and new compositions developed in our lab were comparatively evaluated according to a quantitative swallowability index that describes the mathematical relationship between the critical physical forces governing swallowability. This study showed that the absence of a film coat significantly impeded the ease of tablet gliding properties and formed chalky residues caused by immediate tablet surface erosion. Novel gelatin- and λ-carrageenan-based film coats exhibited an enhanced lubricity, lesser resistance to tangential motion, and reduced stickiness than polyvinyl alcohol (PVA)–PEG graft copolymer, hydroxypropyl methylcellulose (HPMC), and PVA-coated tablets; however, Opadry® EZ possessed the lowest friction–adhesion profile at 1.53 a.u., with the lowest work of adhesion profile at 1.28 J/mm2. For the first time, the in vitro analytical framework in this study provides a fast, cost-effective, and repeatable swallowability ranking method to screen the in vitro swallowability of solid oral medicines in an effort to aid formulators and the pharmaceutical industry to develop easy-to-swallow formulations.

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