Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts 02111, USA.
J Neurointerv Surg. 2011 Dec 1;3(4):340-3. doi: 10.1136/jnis.2010.004499. Epub 2011 Mar 9.
The Enterprise (EN) vascular reconstruction device is a self-expanding nitinol stent used as adjunctive support in wide-necked aneurysm coiling. We sought to evaluate the effect of deployment technique on how well the EN stent conforms to the vessel wall around a curve.
A flow model consisting of a 3.5 mm diameter silicone tube forming a 7 mm radius curve was visualized using high-resolution flat-panel CT (FPCT; DynaCT). EN stents (4.5 mm × 22 mm) were deployed using three methods: (1) microcatheter pull-back, (2) delivery microwire push and (3) a combination of both methods so as to keep the microcatheter tip centered within the lumen during deployment. FPCT images were visualized using multiplanar reconstruction for evidence of incomplete stent apposition (ISA).
FPCT revealed a critical role for deployment method in stent-wall apposition as noted by the development of a crescent-shaped gap between the stent and the wall. Specifically, the manufacturer-recommended microcatheter pull-back unsheathing technique (method 1) resulted in outer curve ISA, while the microwire push technique (method 2) led to inner curve ISA. Using method 3 in a dynamic push-pull manner minimized both inner and outer curve ISA.
The deployment method used to deliver the EN vascular reconstruction device plays a critical role in determining how well its struts appose the vessel wall in vitro. This characteristic must be taken into account when deploying this flexible low-profile stent to avoid ISA in even mildly tortuous anatomy given the possible link between stent malapposition and thromboembolic complications.
Enterprise（EN）血管重建装置是一种自膨式镍钛诺支架，用作宽颈动脉瘤线圈的辅助支撑。我们旨在评估部署技术对 EN 支架在曲线上与血管壁贴合程度的影响。
使用高分辨率平板 CT（FPCT；DynaCT）可视化由 3.5 毫米直径硅树脂管形成 7 毫米半径曲线的流模型。使用三种方法部署 EN 支架（4.5 毫米×22 毫米）：（1）微导管回缩，（2）输送微丝推送，（3）结合这两种方法，以便在部署过程中使微导管尖端保持在管腔中心。使用多平面重建可视化 FPCT 图像，以证明支架壁贴合不完全（ISA）。
FPCT 揭示了部署方法在支架壁贴合中的关键作用，这表现在支架和壁之间形成新月形间隙。具体来说，制造商推荐的微导管回缩解鞘技术（方法 1）导致外曲线 ISA，而微丝推送技术（方法 2）导致内曲线 ISA。以动态推-拉方式使用方法 3可最大限度地减少内曲线和外曲线 ISA。
用于输送 EN 血管重建装置的部署方法在确定其支柱在体外与血管壁贴合程度方面起着关键作用。在部署这种灵活的低轮廓支架时，必须考虑到这一特性，以避免在轻度扭曲的解剖结构中发生 ISA，因为支架贴壁不良与血栓栓塞并发症之间可能存在关联。
