P-026 The use of high-frequency optical coherence tomography for follow-up imaging of treated aneurysms. (22nd July 2019)

• Record Type: Journal Article
• Authors: King, R; Marsofoi, M; Langan, E; Shazeeb, M; Ughi, G; Raskett, C; Puri, A; Gounis, M
• Is Part Of: Journal of neurointerventional surgery. Volume 11(2019)Supplement 1
• Page Start: A39
• Page End: A40
• Publication Date: 2019-07-22
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2019-SNIS.62
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: The use of flow diverters has emerged as an effective treatment of aneurysm. One of the major limitations of flow diverters is the need to put patients on dual anti-platelet therapy (DAPT). The exposure of bare metal struts leads to platelet activation. A method to assess the degree of neointimal tissue ingrowth over the surface of the device could permit patient-specific tailoring of DAPT. Currently, the standard of follow-up for flow diverter patients is digital subtraction angiography (DSA); however, it has been previously reported DSA appearance of complete aneurysm occlusion is not always reliable with continued aneurysm growth. 1 There have been reported cases of very delayed complications after DAPT has been stopped, 2 although rare, such complications can be catastrophic. High Frequency Optical Coherence Tomography (HF-OCT) is a novel intravascular imaging technique designed for use in cerebrovascular anatomy with a spatial resolution approaching 10 microns. In this study, we sought to compare HF-OCT with state-of-the-art DSA for the in vivo evaluation of complete aneurysm occlusion. Methods: Flow diverters were implanted in 15 rabbits, at least 21 days after a standard elastase aneurysm creation. Six of the rabbits were imaged at 15 days post implant, including both DSA and HF-OCT to assess healing of the aneurysm. The remaining 9 rabbits were allowed to heal for 60 days, at which point they also received HF-OCT. Finally, the rabbits were euthanized, perfused with formalin, and the aneurysms were explanted for histological analysis. Results: Fifteen days following implant, one aneurysm was seen to be fully occluded on DSA, but HF-OCT demonstrated an aneurysm remnant, and the struts remained uncovered (figure 1D-E). At 60 days post-implant, another aneurysm appeared fully healed on DSA, yet HF-OCT demonstrated that the aneurysm remained in communication with the parent artery (figure 1A-B). This observation was later confirmed on SEM (figure C). Conclusions: Preliminary evidence is presented showing that DSA alone is insufficient to confirm complete aneurysm occlusion. HF-OCT may reliably show parent artery remodeling and inform patient-specific decisions regarding duration of DAPT. References: AJNR June 2012;33(6):1150–1155. J Neurosurg 2016;125:929–935. Disclosures: R. King: None. M. Marsofoi: None. E. Langan: None. M. Shazeeb: None. G. Ughi: 4; C; Gentuity LLC. 5; C; Gentuity LLC. C. Raskett: None. A. Puri: None. M. Gounis: None.