David Lindström , Anders Wanhainen , Kevin Mani , Giuseppe Asciutto
{"title":"利用血管内超声评估主动脉内移植物原位激光瘘中的桥接支架","authors":"David Lindström , Anders Wanhainen , Kevin Mani , Giuseppe Asciutto","doi":"10.1016/j.ejvsvf.2024.05.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Treatment of complex aortic aneurysms with the <em>in situ</em> laser fenestration (ISLF) technique involves implantation of a balloon expandable stent graft (bSG) in the created fenestration. Adequate expansion of this bSG is of importance both to achieve seal and to ensure target vessel stability. This experimental study assessed the expansion rate of different bSGs in the ISLF setting using intravascular ultrasound (IVUS).</p></div><div><h3>Methods</h3><p>A commercially available aortic endograft was used to test the laser fenestration technique (Zenith Alpha, Cook Medical LLC, Bloomington, IN, USA). The ISLF was stented with the following bSGs: two Gore Viabahn VBX balloon expandable endoprostheses (WL Gore & Associates, Bloomington, IL, USA), three BeGraft Peripheral and three BeGraft Plus (Bentley InnoMed GmbH; Hechingen, Germany), and three Advanta V12 (Atrium, Hudson, NH, USA). The bSGs were expanded in three steps: (1) nominal, (2) rated burst pressure, and (3) dilation with a non-compliant balloon at 15 atmospheres. After each step, an IVUS assessment of the bSG minimum diameter and the area at the fenestration (FA) and in a fully expanded segment distal to the fenestration (SA) was performed. A mean of the three IVUS measurements was used as the value for comparison. An insufficient bSG expansion was defined as a mean of FA/SA of <0.8 (i.e., <80% expansion).</p></div><div><h3>Results</h3><p>The VBX was the only bSG that could be expanded to its intended diameter (i.e., at least 80%) at nominal pressure. The BeGraft Peripheral and BeGraft Plus had the lowest degree of expansion after nominal and rated burst pressure. All bSGs that were tested reached a sufficient expansion degree after using a higher pressure balloon.</p></div><div><h3>Conclusion</h3><p>In this <em>ex vivo</em> experiment, dilation up to nominal pressure showed satisfactory expansion only for the VBX. The consistency of the results when applied to the different types of stent grafts that were analysed reflects structural stent graft specific issues to consider when choosing the right device in cases of ISLF.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000881/pdfft?md5=719ca6a7767179f9a56672f94e760625&pid=1-s2.0-S2666688X24000881-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Assessment of Bridging Stents in In Situ Laser Fenestrations of Aortic Endografts With Intravascular Ultrasound\",\"authors\":\"David Lindström , Anders Wanhainen , Kevin Mani , Giuseppe Asciutto\",\"doi\":\"10.1016/j.ejvsvf.2024.05.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Treatment of complex aortic aneurysms with the <em>in situ</em> laser fenestration (ISLF) technique involves implantation of a balloon expandable stent graft (bSG) in the created fenestration. Adequate expansion of this bSG is of importance both to achieve seal and to ensure target vessel stability. This experimental study assessed the expansion rate of different bSGs in the ISLF setting using intravascular ultrasound (IVUS).</p></div><div><h3>Methods</h3><p>A commercially available aortic endograft was used to test the laser fenestration technique (Zenith Alpha, Cook Medical LLC, Bloomington, IN, USA). The ISLF was stented with the following bSGs: two Gore Viabahn VBX balloon expandable endoprostheses (WL Gore & Associates, Bloomington, IL, USA), three BeGraft Peripheral and three BeGraft Plus (Bentley InnoMed GmbH; Hechingen, Germany), and three Advanta V12 (Atrium, Hudson, NH, USA). The bSGs were expanded in three steps: (1) nominal, (2) rated burst pressure, and (3) dilation with a non-compliant balloon at 15 atmospheres. After each step, an IVUS assessment of the bSG minimum diameter and the area at the fenestration (FA) and in a fully expanded segment distal to the fenestration (SA) was performed. A mean of the three IVUS measurements was used as the value for comparison. An insufficient bSG expansion was defined as a mean of FA/SA of <0.8 (i.e., <80% expansion).</p></div><div><h3>Results</h3><p>The VBX was the only bSG that could be expanded to its intended diameter (i.e., at least 80%) at nominal pressure. The BeGraft Peripheral and BeGraft Plus had the lowest degree of expansion after nominal and rated burst pressure. All bSGs that were tested reached a sufficient expansion degree after using a higher pressure balloon.</p></div><div><h3>Conclusion</h3><p>In this <em>ex vivo</em> experiment, dilation up to nominal pressure showed satisfactory expansion only for the VBX. The consistency of the results when applied to the different types of stent grafts that were analysed reflects structural stent graft specific issues to consider when choosing the right device in cases of ISLF.</p></div>\",\"PeriodicalId\":36502,\"journal\":{\"name\":\"EJVES Vascular Forum\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2666688X24000881/pdfft?md5=719ca6a7767179f9a56672f94e760625&pid=1-s2.0-S2666688X24000881-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"EJVES Vascular Forum\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666688X24000881\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"EJVES Vascular Forum","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666688X24000881","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Assessment of Bridging Stents in In Situ Laser Fenestrations of Aortic Endografts With Intravascular Ultrasound
Objective
Treatment of complex aortic aneurysms with the in situ laser fenestration (ISLF) technique involves implantation of a balloon expandable stent graft (bSG) in the created fenestration. Adequate expansion of this bSG is of importance both to achieve seal and to ensure target vessel stability. This experimental study assessed the expansion rate of different bSGs in the ISLF setting using intravascular ultrasound (IVUS).
Methods
A commercially available aortic endograft was used to test the laser fenestration technique (Zenith Alpha, Cook Medical LLC, Bloomington, IN, USA). The ISLF was stented with the following bSGs: two Gore Viabahn VBX balloon expandable endoprostheses (WL Gore & Associates, Bloomington, IL, USA), three BeGraft Peripheral and three BeGraft Plus (Bentley InnoMed GmbH; Hechingen, Germany), and three Advanta V12 (Atrium, Hudson, NH, USA). The bSGs were expanded in three steps: (1) nominal, (2) rated burst pressure, and (3) dilation with a non-compliant balloon at 15 atmospheres. After each step, an IVUS assessment of the bSG minimum diameter and the area at the fenestration (FA) and in a fully expanded segment distal to the fenestration (SA) was performed. A mean of the three IVUS measurements was used as the value for comparison. An insufficient bSG expansion was defined as a mean of FA/SA of <0.8 (i.e., <80% expansion).
Results
The VBX was the only bSG that could be expanded to its intended diameter (i.e., at least 80%) at nominal pressure. The BeGraft Peripheral and BeGraft Plus had the lowest degree of expansion after nominal and rated burst pressure. All bSGs that were tested reached a sufficient expansion degree after using a higher pressure balloon.
Conclusion
In this ex vivo experiment, dilation up to nominal pressure showed satisfactory expansion only for the VBX. The consistency of the results when applied to the different types of stent grafts that were analysed reflects structural stent graft specific issues to consider when choosing the right device in cases of ISLF.