Neurointervention.  2020 Nov;15(3):117-125. 10.5469/neuroint.2020.00248.

Bench-Top Comparison of Three Different Types of Stents Used for Treatment of Intracranial Atherosclerotic Stenosis

Affiliations
  • 1Department of Neurysurgery, Jeonbuk National University Hospital, Jeonju, Korea
  • 2Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
  • 3Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Jeonju, Korea

Abstract

Purpose
Four key bench-top tests, including trackability, conformability, wall-apposition, and bending stiffness, were performed to understand the mechanical characteristics in 3 different types of stents applicable for treatment of intracranial atherosclerotic stenosis: Balloon-expandable D+Storm, Pro-Kinetic Energy, and self-expandable Wingspan stents.
Materials and Methods
Trackability was assessed by measuring the tracking forces of each stent with its delivery systems. Conformability and wall apposition were quantified and analyzed using curved vessel models. A 3-point bending test was employed to evaluate bending stiffness.
Results
D+Storm showed the lowest tracking forces while the conformability of the Wingspan stent was superior to that of the tested stents. Pro-Kinetic Energy and D+Storm had better wall apposition in curved vessels than the Wingspan stent. Bending stiffness of the Wingspan stent was notably lower, whereas no significant differences were found between D+Storm and Energy. Pro-Kinetic Energy and D+Storm not only indicated lower gap ratios between the struts and the vessel wall but also maintained good wall apposition even in the curved model.
Conclusion
These bench-top measurements may provide clinicians with useful information in regard to selecting suitable stents for treatment of intracranial atherosclerotic stenosis.

Keyword

Intracranial arterial disease; Atherosclerosis; Stent

Figure

  • Fig. 1. Vessel model and stent system for trackability tests: (A) D+Storm and Pro-Kinetic Energy stent system, and (B) Wingspan stent system.

  • Fig. 2. Schematic images of angle variations of the tested stents (A) before and (B) after stent deployment in the curved segment.

  • Fig. 3. Images of test setup of the 3-point bending test for measuring bending stiffness.

  • Fig. 4. Tracking force-distance curves of trackability measurements: (A) D+Storm, (B) Pro-Kinetic Energy, and (C) Wingspan.

  • Fig. 5. Images of angle variation results for measurements of conformability (in the following order): D+Storm, Pro-Kinetic Energy, and Wingspan.

  • Fig. 6. Images of stent-vessel wall apposition measurements (D+Storm, Pro-Kinetic Energy, and Wingspan stents, respectively).

  • Fig. 7. Images of apposed stents to the curved vessel wall: D+Storm, Pro-Kinetic Energy, and Wingspan.

  • Fig. 8. Graphs displaying bending force-displacement curves for measurement of bending stiffness: (A) D+Storm, (B) Pro-Kinetic Energy, and (C) Wingspan.


Reference

1. Feigin VL. Stroke in developing countries: can the epidemic be stopped and outcomes improved? Lancet Neurol. 2007; 6:94–97.
Article
2. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007; 6:182–187.
Article
3. Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014; 312:259–268.
Article
4. Gorelick PB, Wong KS, Bae HJ, Pandey DK. Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke. 2008; 39:2396–2399.
5. Wong LK. Global burden of intracranial atherosclerosis. Int J Stroke. 2006; 1:158–159.
Article
6. Thijs VN, Albers GW. Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therapy. Neurology. 2000; 55:490–497.
Article
7. Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, et al. The warfarin-aspirin symptomatic intracranial disease study. Neurology. 1995; 45:1488–1493.
Article
8. Luo J, Wang T, Gao P, Krings T, Jiao L. Endovascular treatment of intracranial atherosclerotic stenosis: current debates and future prospects. Front Neurol. 2018; 9:666.
Article
9. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005; 352:1305–1316.
Article
10. Kasner SE, Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, et al. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation. 2006; 113:555–563.
Article
11. Turan TN, Derdeyn CP, Fiorella D, Chimowitz MI. Treatment of atherosclerotic intracranial arterial stenosis. Stroke. 2009; 40:2257–2261.
Article
12. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C. Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. AJNR Am J Neuroradiol. 2002; 23:430–436.
13. Mori T, Kazita K, Mori K. Cerebral angioplasty and stenting for intracranial vertebral atherosclerotic stenosis. AJNR Am J Neuroradiol. 1999; 20:787–789.
14. SSYLVIA Study Investigators. Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results. Stroke. 2004; 35:1388–1392.
15. Kimura T, Yokoi H, Nakagawa Y, Tamura T, Kaburagi S, Sawada Y, et al. Three-year follow-up after implantation of metallic coronary-artery stents. N Engl J Med. 1996; 334:561–566.
Article
16. Vajda Z, Miloslavski E, Güthe T, Schmid E, Schul C, Albes G, et al. Treatment of intracranial atherosclerotic arterial stenoses with a balloon-expandable cobalt chromium stent (Coroflex Blue): procedural safety, efficacy, and midterm patency. Neuroradiology. 2010; 52:645–651.
Article
17. Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I, et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke. 2007; 38:1531–1537.
18. Zaidat OO, Klucznik R, Alexander MJ, Chaloupka J, Lutsep H, Barnwell S, NIH Multi-center Wingspan Intracranial Stent Registry Study Group, et al. The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis. Neurology. 2008; 70:1518–1524.
Article
19. Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL Jr, et al. Angiographic patterns of Wingspan in-stent restenosis. Neurosurgery. 2008; 63:23–27. discussion 27-28.
Article
20. Miao Z, Zhang Y, Shuai J, Jiang C, Zhu Q, Chen K, Study Group of Registry Study of Stenting for Symptomatic Intracranial Artery Stenosis in China, et al. Thirty-day outcome of a multicenter registry study of stenting for symptomatic intracranial artery stenosis in China. Stroke. 2015; 46:2822–2829.
Article
21. Liu L, Zhao X, Mo D, Ma N, Gao F, Miao Z. Stenting for symptomatic intracranial vertebrobasilar artery stenosis: 30-day results in a high-volume stroke center. Clin Neurol Neurosurg. 2016; 143:132–138.
Article
22. Rohde S, Seckinger J, Hähnel S, Ringleb PA, Bendszus M, Hartmann M. Stent design lowers angiographic but not clinical adverse events in stenting of symptomatic intracranial stenosis - results of a single center study with 100 consecutive patients. Int J Stroke. 2013; 8:87–94.
Article
23. Wang Q, Fang G, Zhao Y, Wang G, Cai T. Computational and experimental investigation into mechanical performances of Poly-L-Lactide Acid (PLLA) coronary stents. J Mech Behav Biomed Mater. 2017; 65:415–427.
Article
24. du Mesnil de Rochemont R, Yan B, Zanella FE, Rüfenacht DA, Berkefeld J. Conformability of balloon-expandable stents to the carotid siphon: an in vitro study. AJNR Am J Neuroradiol. 2006; 27:324–326.
25. Gao B, Baharoglu MI, Cohen AD, Malek AM. Stent-assisted coiling of intracranial bifurcation aneurysms leads to immediate and delayed intracranial vascular angle remodeling. AJNR Am J Neuroradiol. 2012; 33:649–654.
Article
26. Siqueira DA, Abizaid AA, Costa Jde R, Feres F, Mattos LA, Staico R, et al. Late incomplete apposition after drug-eluting stent implantation: incidence and potential for adverse clinical outcomes. Eur Heart J. 2007; 28:1304–1309.
Article
27. Heller RS, Malek AM. Parent vessel size and curvature strongly influence risk of incomplete stent apposition in enterprise intracranial aneurysm stent coiling. AJNR Am J Neuroradiol. 2011; 32:1714–1720.
Article
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