Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
Neurosurgery. 2020 Nov 16;87(6):1311-1319. doi: 10.1093/neuros/nyaa208.
Tissue growth over covered branches is a leading cause of delayed thrombotic complications after flow-diverter stenting (FDS). Due to insufficient resolution, no imaging modality is clinically available to monitor this phenomenon.
To evaluate high-frequency optical coherence tomography (HF-OCT), a novel intravascular imaging modality designed for the cerebrovascular anatomy with a resolution approaching 10 microns, to monitor tissue growth over FDS in an arterial bifurcation model.
FDS were deployed in a rabbit model (n = 6), covering the aortic bifurcation. The animals were divided in different groups, receiving dual antiplatelet therapy (DAPT) (n = 4), aspirin only (n = 1), and no treatment (n = 1). HF-OCT data were obtained in vivo at 3 different time points in each animal. For each cross-sectional image, metal and tissue coverage of the jailed ostium was quantified. Scanning electron microscopy images of harvested arteries were subsequently obtained.
Good quality HF-OCT data sets were successfully acquired at implant and follow-up. A median value of 41 (range 21-55) cross-sectional images were analyzed per ostium for each time point. Between 0 and 30 d after implant, HF-OCT analysis showed a significantly higher ostium coverage when DAPT was not given. After 30 d, similar growth rates were found in the DAPT and in the aspirin group. At 60 d, a coverage of 90% was reached in all groups.
HF-OCT enables an accurate visualization of tissue growth over time on FDS struts. The use of FDS in bifurcation locations may induce a drastic reduction of the jailed-branch ostium area.
在血流导向装置支架（FDS）置入后，覆盖分支的组织生长是导致血栓并发症延迟的主要原因。由于分辨率不足，目前还没有临床可用的成像方式来监测这种现象。
评估高频光学相干断层扫描（HF-OCT），这是一种新型的血管内成像方式，专为脑血管解剖结构设计，分辨率接近 10 微米，以监测 FDS 在动脉分叉模型中的组织生长。
在兔模型中（n=6）部署 FDS，覆盖主动脉分叉。将动物分为不同的组，接受双重抗血小板治疗（DAPT）（n=4）、仅接受阿司匹林治疗（n=1）和不治疗（n=1）。在每个动物的 3 个不同时间点进行体内 HF-OCT 数据采集。对于每个横截面图像，量化了被监禁的开口处的金属和组织覆盖。随后获得了收获的动脉的扫描电子显微镜图像。
成功地在植入物和随访时获得了高质量的 HF-OCT 数据集。每个时间点每个开口分析的中位数为 41 个（范围 21-55 个）横截面图像。在植入后 0 至 30 天内，当不给予 DAPT 时，HF-OCT 分析显示开口处的覆盖明显更高。30 天后，DAPT 和阿司匹林组的生长速度相似。60 天时，所有组的覆盖面积达到 90%。
HF-OCT 能够准确地可视化 FDS 支架上随时间的组织生长。在分叉位置使用 FDS 可能会导致被监禁分支的开口区域急剧减少。
