by Neurovascular devices are minimally invasive medical tools used for the treatment of cerebrovascular conditions such as strokes. These devices allow physicians to access the neurovasculature without requiring extensive surgical procedures. Some key types of neurovascular devices and how they are used will be explored below.
Coiling Devices for Aneurysm Treatment
One of the most common applications of Neurovascular Devices is in the endovascular coiling of brain aneurysms. A brain aneurysm is a bulging, weak area in the wall of an artery in the brain that can rupture and cause life-threatening bleeding in the skull known as a hemorrhagic stroke. Coiling devices, also called embolization coils, work by being packed into an aneurysm through a thin catheter inserted via the groin to block blood flow into the aneurysm, preventing it from rupturing.
The coils are made of platinum, platinum alloys, or cobalt-chromium alloys and are very soft and flexible to navigate the neurovasculature. Under fluoroscopic guidance, the coils conform to the shape of the aneurysm and form a dense mass to occlude the aneurysm from circulation over time. Coiling has emerged as a less invasive alternative to neurosurgical clipping of aneurysms and has shown high rates of aneurysm occlusion with lower risks compared to open surgery.
Stent Retrievers for Ischemic Stroke Thrombectomy
For patients experiencing an ischemic stroke due to a large vessel occlusion, emergent removal of the clot through thrombectomy with a stent retriever has become the standard of care. These devices work by being placed at the site of the clot and expanded to capture the clot before being retracted, pulling it out of the vessel.
Stent retrievers come pre-loaded on a microcatheter for navigation through tortuous anatomy. Under imaging guidance, they are positioned across the clot before being deployed via unsheathing or balloon expansion. Various designs including closed cell and open cell configurations aim to maximize clot engagement. Stent retrievers have demonstrated significantly improved functional outcomes compared to medical management alone in large clinical trials.
Flow Diverters for Cerebral Aneurysm Treatment
For very large or giant aneurysms not amenable to coiling, flow diverting stents may offer an alternative endovascular approach. These stents are mesh-like braided or woven devices of nickel-titanium or platinum alloy constructed to reduce blood flow into the aneurysm while maintaining parent vessel patency.Due to their fine mesh design allowing endothelialization, flow diverters can induce progressive thrombosis of the aneurysm sac over time rather than acute occlusion like coiling. This may make them safer for larger aneurysms at higher risk of rupture from coil packing. However, they require dual antiplatelet therapy that carries bleeding risks. Larger studies continue to evaluate long term outcomes with this newer technology.
Drug Eluting Devices for Intracranial Atherosclerosis
For patients with severe intracranial atherosclerosis causing stroke, drug eluting technologies are an area of active research. These include drug coated balloon angioplasty catheters and drug eluting stents to treat stenosis in the intracranial arteries.
Paclitaxel is commonly used due to its antiproliferative properties, with the goal of inhibiting restenosis post angioplasty. Early studies show promise for reducing re-stenosis compared to angioplasty alone, but larger randomized controlled trials are still needed. Technical challenges accessing smaller intracranial vessels have hampered progress in this area compared to the coronary circulation.
Neurovascular Simulation and Virtual Reality
Simulation and virtual reality are enhancing neurovascular training and surgical planning. 3D angiogram reconstruction, vessel segmentation, and virtual procedural planning allow physicians to trial different technical approaches prior to an actual case. Immersive VR interfaces are being developed to give neurointerventionalists a realistic simulated experience of catheter navigation and device deployment.
This is important for technical skill development early in training, as well as complex retreatment planning. Integrating intraoperative imaging also enables correlation to simulated models for real-time navigation and outcomes assessment. As image guidance and neurovascular simulation continue advancing, they hold promise to improve safety, efficiency and optimization of patient-specific treatment strategies.
Regulatory Environment and Ongoing Advancements
Rigorous preclinical and clinical testing is required by the FDA to demonstrate safety and efficacy of new neurovascular devices before market approval and adoption. There have also been advancements in the field of regulatory science to better incorporate real world data for postmarket device surveillance. Collaborative networks support continued innovation through multicenter prospective registries as well as investigator-initiated clinical trials.
Overall, neurovascular devices represent a promising area for less invasive stroke treatment options compared to open surgery. Balloon guide catheters, microcatheters, imaging coils and stents continue evolving to improve outcomes for cerebral aneurysms, arterial occlusions and other cerebrovascular conditions. With ongoing technological refinement and integration of simulation, these tools are poised to transform stroke intervention.
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1. Source: Coherent Market Insights, Public sources, Desk research.
2. We have leveraged AI tools to mine information and compile it.
