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Preclinical Evaluation of the Accero Stent: Flow Remodelling Effect on Aneurysm, Vessel Reaction and Side Branch Patency

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Abstract

Purpose

It has been hypothesized that microstents which are used to prevent coil protrusion in the treatment of cerebral aneurysms may have flow diverting and therefore occlusive effects. In a rabbit elastase aneurysm model, we investigated the aneurysm occlusion rate and vessel reaction of a braided Accero stent prototype with porosity in the lower range of other available (non-flow-diverter) microstents.

Methods

Ten aneurysms were induced the right subclavian artery in New Zealand white rabbits and treated with the Accero stent prototype. In each subject, a second stent was implanted in the abdominal aorta to cover the origins of branch arteries. Angiographic follow-up and explantation of the devices and aneurysms for histological analysis were performed after 3 months (n = 5) and 6 months (n = 5).

Results

Grades I (< 50%) and II (> 50%) occlusion rates were observed in 9 (90%) and 1 (10%) of ten aneurysms treated with the stent device. The mean reduction in contrast filling at 6 months was 42.1% (p = .02). Neointima thickness was significantly higher in the subclavian artery than in the abdominal aorta after 3 (p = .03), whereas not after 6 months (p = .1). No cases of inadequate wall apposition, branch artery occlusion or stent thrombosis were observed.

Conclusion

The present study showed flow remodelling properties of the device prototype with progredient aneurysm occlusion. A larger in vivo study with induced aneurysm should be done to confirm these results.

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Funding

This work was supported by the German Ministry of Economic Affairs and Energy (Grant No KF2335804AJ2) and partially funded by Acandis GmbH, Pforzheim, Germany.

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Authors and Affiliations

  1. Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg/Saar, Germany

    Ruben Mühl-Benninghaus, Rabie Abboud, Andreas Simgen, Toshiki Tomori, Umut Yilmaz & Wolfgang Reith

  2. Acandis GmbH, Pforzheim, Germany

    Andeas Ding

  3. Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany

    Stefanie Krajewski

  4. Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital, Homburg/Saar, Germany

    Hagen Bomberg

  5. Department of Pathology, University of Regensburg, Regensburg, Germany

    Christoph Brochhausen

  6. Institute for Biomedical Engineering, University of Stuttgart, Stuttgart, Germany

    Giorgio Cattaneo

Authors
  1. Ruben Mühl-Benninghaus
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Correspondence to Ruben Mühl-Benninghaus.

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Conflict of interest

Giorgio Cattaneo was engineer at the company Acandis GmbH until August 2019, Andreas Ding is engineer at the company Acandis GmbH (Pforzheim, Germany). Both served as proctors during this study.

Ethical Approval

All applicable international, national and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. This study obtained approval by the local animal protection committee (No. 44/13).

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Mühl-Benninghaus, R., Abboud, R., Ding, A. et al. Preclinical Evaluation of the Accero Stent: Flow Remodelling Effect on Aneurysm, Vessel Reaction and Side Branch Patency. Cardiovasc Intervent Radiol 42, 1786–1794 (2019). https://doi.org/10.1007/s00270-019-02345-z

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