Farzaneh Sina, Jiménez Juan Miguel
Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA.
Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA, USA.
Ann Biomed Eng. 2025 Apr 17. doi: 10.1007/s10439-025-03724-z.
PURPOSE: Flow diverter stents (FDS) are used to treat aneurysms by modifying the intraaneurysmal hemodynamics and promoting a prothrombotic milieu. Thrombotic in-stent stenosis (ISS) is a common complication of endovascular treatment for intracranial aneurysms with flow diverter stents. The dominant approach to address ISS has been to either increase the dose of antiplatelet therapy agents or extend dual antiplatelet therapy (DAPT) causing ISS to resolve, while potentially exacerbating the side effects associated with DAPT. To decrease the risk of thrombotic ISS, surface coatings have been applied to flow diverter stents with promising results. METHODS: The thrombotic signature of a bare metal and a heparin coated FDS was assessed in vitro. The flow diverter stents were exposed to pulsatile blood flow in a one-pass system to assess platelet and fibrin deposition, while flow cytometry was used to assess different markers of platelet activation in blood incubated with flow diverter stents for 30, 60, and 90 minutes. RESULTS: Immunofluorescence and scanning electron microcopy results demonstrated greater fibrin and platelet deposition on bare metal flow diverter stents, while the heparin coated flow diverter stents had less fibrin and platelet deposition. A greater percentage of platelets were not only activated, but also presented higher levels of activation markers, in blood exposed to the bare metal flow diverter stents at the 90 minute time point in comparison to the heparin coated FDS. CONCLUSION: The findings demonstrate that heparin coated flow diverter stents are characterized by a lower thrombotic signature than bare metal flow diverter stents and raise the possibility of an additional therapeutic option to treat intracranial aneurysms.
目的:血流导向支架(FDS)通过改变动脉瘤内的血流动力学并促进血栓形成环境来治疗动脉瘤。血栓性支架内狭窄(ISS)是颅内动脉瘤血流导向支架血管内治疗的常见并发症。解决ISS的主要方法是增加抗血小板治疗药物的剂量或延长双联抗血小板治疗(DAPT)以使ISS消退,同时可能加剧与DAPT相关的副作用。为降低血栓性ISS的风险,已将表面涂层应用于血流导向支架并取得了有前景的结果。 方法:在体外评估裸金属和肝素涂层FDS的血栓形成特征。将血流导向支架在单通道系统中暴露于脉动血流,以评估血小板和纤维蛋白沉积,同时使用流式细胞术评估与血流导向支架孵育30、60和90分钟的血液中血小板活化的不同标志物。 结果:免疫荧光和扫描电子显微镜结果表明,裸金属血流导向支架上的纤维蛋白和血小板沉积更多,而肝素涂层血流导向支架上的纤维蛋白和血小板沉积较少。与肝素涂层FDS相比,在90分钟时间点暴露于裸金属血流导向支架的血液中,不仅有更大比例的血小板被激活,而且其活化标志物水平更高。 结论:研究结果表明,肝素涂层血流导向支架的血栓形成特征低于裸金属血流导向支架,并增加了治疗颅内动脉瘤的另一种治疗选择的可能性。
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