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稳定器装置在神经血管内治疗中的首次人体试验。

First-in-human trial of Stabilizer device in neuroendovascular therapy.

作者信息

Sakai Chiaki, Sakai Nobuyuki, Takayanagi Ariel, Imamura Hirotoshi, Ohta Tsuyoshi, Koyanagi Masaomi, Goto Masanori, Fukumitsu Ryu, Sunohara Tadashi, Fukui Nobuyuki, Matsumoto Shirabe, Akiyama Tomoaki, Takano Yuki, Haruyama Hironori, Go Koichi, Kajiura Shinji, Shigeyasu Masashi, Asakura Kento, Horii Ryo, Naramoto Yuji, Nishii Rikuo, Yamamoto Yasuhiro, Teranishi Kunimasa, Kawade Satohiro, Imahori Taichiro, Kaneko Naoki, Tateshima Satoshi

机构信息

Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan.

Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.

出版信息

Heliyon. 2023 Mar 11;9(3):e14360. doi: 10.1016/j.heliyon.2023.e14360. eCollection 2023 Mar.

Abstract

OBJECTIVES

Flow diverter or stent implantation to intracranial target lesion requires large inner diameter microcatheter navigation. The exchange method using stiff long wire is often necessary if it is difficult to navigate over the regular guidewire. However, this method has an intrinsic risk of vessel damage and may cause severe complications. We investigated the safety and efficacy of a new device, the Stabilizer device for navigation in a first-in-human clinical trial under the Certified Review Board agreement.

MATERIALS AND METHODS

The Stabilizer is a 320 cm length exchange wire with a stent for anchoring and is compatible with a 0.0165" microcatheter. The trial design is a prospective single-arm open-label registry. Inclusion criteria are elective flow diverter treatment or stent-assisted coiling, expected to be difficult to navigate a microcatheter with a regular micro guidewire, and obtained documented consent. The primary endpoint of the study was a hemorrhagic complication.

RESULTS

Five patients were enrolled in this trial. The median age is 52 years, ranges from 41 to 70, and all patients were female. Three aneurysms were located on the internal carotid artery, one on the vertebral artery, and one on the basilar artery. Basilar artery aneurysm was treated by stent-assisted coiling and others were treated by flow diverter deployment. All cases successfully navigate microcatheter for the treatment by the trial method using Stabilizer device without any adverse event.

CONCLUSIONS

The results from this first-in-human consecutive five cases show the safety of the Stabilizer device in neuro-endovascular therapy for navigation of devices to the intracranial target lesion.

摘要

目的

将血流导向装置或支架植入颅内靶病变需要大内径微导管导航。如果难以通过常规导丝进行导航,通常需要使用硬长导丝的交换方法。然而,这种方法存在血管损伤的固有风险,可能会导致严重并发症。我们根据认证审查委员会的协议,在一项首次人体临床试验中研究了一种新装置——用于导航的稳定器装置的安全性和有效性。

材料与方法

稳定器是一根320厘米长的带支架用于锚定的交换导丝,与0.0165英寸的微导管兼容。试验设计为前瞻性单臂开放标签注册研究。纳入标准为择期血流导向治疗或支架辅助弹簧圈栓塞、预计难以通过常规微导丝引导微导管以及获得书面同意。该研究的主要终点是出血并发症。

结果

五名患者参加了该试验。中位年龄为52岁,范围在41至70岁之间,所有患者均为女性。三个动脉瘤位于颈内动脉,一个位于椎动脉,一个位于基底动脉。基底动脉动脉瘤采用支架辅助弹簧圈栓塞治疗,其他动脉瘤采用血流导向装置置入治疗。所有病例均通过使用稳定器装置的试验方法成功引导微导管进行治疗,无任何不良事件。

结论

这例首次人体连续五例的结果表明,稳定器装置在神经血管内治疗中将装置导航至颅内靶病变方面是安全的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b38/10025140/904d76b8227a/gr1.jpg

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