Communicating malapposition of flow diverters assessed with optical coherence tomography correlates with delayed aneurysm occlusion

J Neurointerv Surg. 2018 Jul;10(7):693-697. doi: 10.1136/neurintsurg-2017-013502. Epub 2017 Nov 10.


Background: Optical coherence tomography (OCT) is a high resolution intravascular imaging method that allows visualization of flow diverter struts and the vessel wall. In this study, malapposition of the flow diverter that continues into the neck of the aneurysm, named communicating malapposition (CM), was investigated as a potential factor for delayed aneurysm healing.

Methods: 40 New Zealand White rabbits underwent elastase induced aneurysm creation, and were subsequently assigned to one of four treatment groups based on flow diverter type and administration of antiplatelet therapy. All animals underwent post device deployment balloon angioplasty and subsequent OCT to assess device/vessel apposition. The incidence of CM seen on OCT was assessed with a binary scoring system: 0-CM present; 1-CM absent. At 30 days, DSA was acquired to assess aneurysm healing. Aneurysm healing on terminal DSA was measured using a previously developed 5 point scale, with a score of 3 or 4 considered a positive outcome.

Results: All animals were grouped into a single cohort for analysis as no difference in the rate of CM or healing was seen in the four treatment groups. Significant interaction between the absence of CM and a positive outcome was confirmed by Fisher exact test (P=0.0034). Angioplasty was shown to treat 33% of the cases of CM seen at implant, and these treated cases overwhelmingly had a positive outcome (P<0.001).

Conclusion: The use of OCT to assess CM of flow diverters has been shown to be predictive of the 30 day healing rate of an animal model of aneurysms.

Keywords: aneurysm; device; flow diverter.

MeSH terms

  • Animals
  • Blood Vessel Prosthesis / adverse effects
  • Blood Vessel Prosthesis / trends
  • Disease Models, Animal*
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods
  • Female
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / therapy*
  • Male
  • Rabbits
  • Self Expandable Metallic Stents / adverse effects
  • Self Expandable Metallic Stents / trends*
  • Time Factors
  • Tomography, Optical Coherence / methods*