title: Compaction of flow diverters improves occlusion of experimental wide-necked aneurysms.
abstract: BACKGROUND
  Flow diverters (FDs) are increasingly used in the treatment of wide-necked aneurysms.
  
  
  OBJECTIVE
  To examine the hypothesis that intentional FD compaction might improve aneurysm occlusion rates.
  
  
  METHODS
  Bilateral wide-necked carotid aneurysms were created in 12 dogs. Endovascular treatment was performed 1 month later, using Pipeline embolization devices deployed with compaction across the aneurysm neck (n=12). Group 1a consisted of aneurysms treated with a single compacted FD (n=8), while group 1b aneurysms required two compacted FDs (n=4). Control aneurysms were treated with a single non-compacted FD (group 3; n=6), or not treated (group 4; n=4). Angiographic results were compared at 3 months. Pathology specimens were photographed and the neointimal coverage of devices scored using an ordinal grading system.
  
  
  RESULTS
  Twenty-two of 24 aneurysms were patent at 1 month. Deployment with compaction was successful in eight cases (group 1a aneurysms). The compaction maneuver led to immediate FD prolapse into the aneurysm in four cases, rescued by deploying a second, telescoping FD (forming group 1b aneurysms). One compacted device later migrated distally, leaving the aneurysm untreated. Angiographic results differed significantly between groups (p=0.0002). At 3 months, aneurysms successfully treated with a single compacted FD were more often occluded at 3 months (7/7) than aneurysms flow-diverted without compaction (2/6; p=0.021). All aneurysms treated with two compacted FDs were occluded, while all untreated aneurysms remained patent. There were no parent vessel stenoses.
  
  
  CONCLUSIONS
  Compaction of FDs can improve angiographic occlusion of experimental wide-necked aneurysms.
authors.affiliation: Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada Groupe d'étude de la Thrombose en Bretagne Occidentale (GETBO, EA 3878), Brest, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Gentric
authors.affiliation: Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
authors.forename: Igor
authors.identifier: http://orcid.org/0000-0001-6261-5826
authors.initials: I
authors.lastname: Salazkin
authors.affiliation: Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
authors.forename: Guylaine
authors.initials: G
authors.lastname: Gevry
authors.affiliation: Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Raymond
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Darsaut
mesh_terms: D000818:Animals; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D004285:Dogs; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents; D060205:Therapeutic Occlusion / Q000379:methods*
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Aneurysm; Angiography; Flow Diverter