title: Deployment technique that takes advantage of the characteristics of Enterprise VRD2: an in vitro study.
abstract: BACKGROUND
  Enterprise VRD, a stent frequently used to assist coil embolization of cerebral aneurysms, has been upgraded to reduce the risk of incomplete stent apposition (ISA), a known risk factor for thromboembolic complications.
  
  
  OBJECTIVE
  To compare the performances of Enterprise VRD and Enterprise VRD2 in curved vessels, and to investigate a deployment method that takes advantage of the features of Enterprise VRD2 to achieve better vessel wall apposition.
  
  
  METHODS
  A silicone vascular model connected to a temperature-adjustable perfusion circuit was used. First, Enterprise VRD and Enterprise VRD2 were deployed under fluoroscopy and then ISA was evaluated as the stent cross-sectional area ratio at the curved segment of the vessel. For the measurements, each stent was deployed in vessels with different angles of curvature. Second, the incidence of ISA after insertion of Enterprise VRD2 by the 'pushing over outer curve technique', in which stents are deployed along the outer curve of vessels with continuous wire advancement, was compared with 'Heller's push and pull technique'.
  
  
  RESULTS
  For all stents, the cross-sectional area ratio decreased with acute curvature of the vessel. Comparisons of the two stents showed that Enterprise VRD2 was better than Enterprise VRD in maintaining a greater cross-sectional area ratio in curved vessels. In addition, kinking with an acute curvature was also minimized with Enterprise VRD2. Furthermore, ISA was reduced using our technique with Enterprise VRD2.
  
  
  CONCLUSIONS
  Enterprise VRD2 is superior to Enterprise VRD in reducing ISA in curved vessels and can alter ISA according to the deployment technique used.
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Hideo
authors: H
authors: Chihara
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Akira
authors: A
authors: Ishii
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Takayuki
authors: T
authors: Kikuchi
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Hiroyuki
authors: H
authors: Ikeda
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Daisuke
authors: D
authors: Arai
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Susumu
authors: S
authors: Miyamoto
mesh_terms: D001807:Blood Vessel Prosthesis; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D002532:Intracranial Aneurysm / Q000601:surgery; D008954:Models, Biological; D012828:Silicones; D015607:Stents
chemical_list: D012828:Silicones
keywords: Aneurysm; Intervention; Stent; Technique