Delivery technique plays an important role in determining vessel wall apposition of the Enterprise self-expanding intracranial stent

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Abstract

Background

The Enterprise (EN) vascular reconstruction device is a self-expanding nitinol stent used as adjunctive support in wide-necked aneurysm coiling. We sought to evaluate the effect of deployment technique on how well the EN stent conforms to the vessel wall around a curve.

Methods

A flow model consisting of a 3.5 mm diameter silicone tube forming a 7 mm radius curve was visualized using high-resolution flat-panel CT (FPCT; DynaCT). EN stents (4.5 mm×22 mm) were deployed using three methods: (1) microcatheter pull-back, (2) delivery microwire push and (3) a combination of both methods so as to keep the microcatheter tip centered within the lumen during deployment. FPCT images were visualized using multiplanar reconstruction for evidence of incomplete stent apposition (ISA).

Results

FPCT revealed a critical role for deployment method in stent–wall apposition as noted by the development of a crescent-shaped gap between the stent and the wall. Specifically, the manufacturer-recommended microcatheter pull-back unsheathing technique (method 1) resulted in outer curve ISA, while the microwire push technique (method 2) led to inner curve ISA. Using method 3 in a dynamic push–pull manner minimized both inner and outer curve ISA.

Conclusion

The deployment method used to deliver the EN vascular reconstruction device plays a critical role in determining how well its struts appose the vessel wall in vitro. This characteristic must be taken into account when deploying this flexible low-profile stent to avoid ISA in even mildly tortuous anatomy given the possible link between stent malapposition and thromboembolic complications.

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