Patency of Branches after Coverage with Multiple Telescoping Flow-Diverter Devices: An In Vivo Study in Rabbits

D. Dai; Y.H. Ding; R. Kadirvel; A.E. Rad; D.A. Lewis; D.F. Kallmes

doi:10.3174/ajnr.A2879

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Fig 1.
Representative angiograms from each group at 12-month follow-up. A, Subject from the single-PED group. B, Subject from double-PED group. C, Subject from triple-PED group. In each case, the DSA images show that the lumbar arteries covered by the device remain patent. The yellow arrows indicate both ends of the devices, and the dashed yellow arrows indicate the lumbar arteries.
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Fig 2.
Representative photomicrographs from each group at 12 months. A, Subject from the single-PED group with minimal neointima hyperplasia (H&E, original magnification ×25). B and C, Subject from double- and triple-PED groups, respectively, with neointima thicker than that in A. However, the stenosis area was mild, and the aortas are widely patent (H&E, original magnification ×12.5).
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Fig 3.
Photomicrographs of same subjects as in Fig 1 showing the lumbar artery origins. A, Subject from the single PED group with device struts across 2 lumbar arteries. The neointima crossing the ostia of lumbar arteries is discontinuous (arrows); thus, the lumbar arteries are patent (H&E, original magnification ×25). B and C, Subject from double- and triple-PED groups, respectively, with neointima partially covering the ostia of lumbar artery branches. However, this neointima is also discontinuous (arrow); thus, the branch vessels are patent (H&E, original magnification ×40).

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Morphometric measurements^a

Treatment Group	NIT (mm)		Stenosis (%)		Medial Area (mm²)
Treatment Group	6 m	12 m	6 m	12 m	6 m	12 m
Single PED	0.1 ± 0.0	0.1 ± 0.0	8.4 ± 0.6	6.7 ± 1.3	1.3 ± 0.4	1.0 ± 0.1
Double PED	0.2 ± 0.0	0.1 ± 0.0	13.0 ± 1.1	10.4 ± 0.8	0.9 ± 0.1	0.9 ± 0.1
Triple PED	0.2 ± 0.0	0.2 ± 0.0	15.4 ± 1.0	18.0 ± 1.9	1.0 ± 0.1	0.8 ± 0.1

Note:—NIT indicates neointimal thickness.
↵a Data are represented as mean ± SD. NIT is decreased from 6 to 12 months in the double-PED group (P = .0092); there were no significant differences for the single- and triple-PED groups (P = 1.0). At 6 months, the NIT values in the double (P = .0049) and triple (P = .0012) groups are significantly higher than those in the single group. There are no significant differences between double- and triple-PED groups at this time point (P = .4191). At 12 months, the NIT in the triple-PED group is significantly higher than in single- and double-PED groups (P < .001); there are no significant differences between single and double groups (P = 1.0). When the percentage stenosis is examined, there is no difference between 6 and 12 months for the single, double, or triple PED. At 6 months, the percentage stenoses in double and triple groups are both higher than that in the single group (P < .005). There are no significant differences between the double and triple groups (P = .2237). At 12 months, the percentage stenoses for the double (P = .0026) and triple groups (P < .0001) are higher than that in the single group; the percentage stenosis in the triple group is also higher than that in the double group (P < .0001). There are no significant differences in the medial area either for PED groups with time or for PED groups that were examined within each time point.