ArticleFrontiers in neurology
Pilot feasibility study of intraprocedural transcranial Doppler monitoring to assess Heal coating thrombogenicity in flow diversion.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Utility of flow diverter (FD) surface modification (SM) in reducing thromboembolism of cerebral aneurysm treatment remains debated. Prior studies have relied on clinical outcomes or diffusion-weighted MRI (DWI), which are indirect measures of FD-related thrombogenicity. We used transcranial Doppler ultrasonography (TCD), which enables direct intraprocedural detection of thromboembolic events, to compare the thromboembolic potential of the Derivo2 FD and its coated version. Methods: A retrospective review of patients monitored noninvasively by TCD during flow diversion was performed in a tertiary center. Due to the variations in physical properties of the FDs and biochemical properties of their SMs, the most commonly used device type was singled out. TCD recordings of 2 patient groups treated with the bare Derivo2 FD (DFD, group 1) versus its coated version (Derivo 2heal FD, D2H) were compared. Group 1 patients were administered dual antiplatelet therapy (DAPT) and group 2 patients were single antiplatelet therapy (SAPT) before the procedure. Groups were compared for emboli (gaseous versus solid) detected continuously starting from the onset of the procedure and extending to 30 min after FD deployment. DWI was obtained within 3 days postoperatively. Results: 13 patients were treated with DFD under DAPT and 13 with D2H under SAPT (consisting of only clopidogrel or prasugrel in 12 patients and aspirin only in one patient). The bare group had more solid emboli within 30 min after deployment ( Conclusion: In this single-center, hypothesis-generating pilot feasibility study, noninvasive monitoring of thrombi generated during flow diversion was shown to be possible. Although differing antiplatelet regimens across the groups precluded direct comparison, the intraprocedural embolic load in the SAPT-treated D2H group was low, justifying further randomized studies beyond this exploratory study for evaluation of the efficacy of the D2H coating. This study also shows that DWI findings are not reliable specifically for determination of FD thrombogenicity.
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