April 18, 2024

Neuro-interventional Devices: Revolutionizing Treatment of Brain and Spinal Cord Disorders

Neurovascular intervention procedures have gained significant popularity in recent years due to their minimally invasive nature and relatively high success rates compared to open surgeries. With continual technological advancements, neuro-interventional devices are pushing the boundaries of treatment possibilities for various brain and spinal cord disorders. This article discusses some of the major neuro-interventional devices and the impact they are having on patient care.

Embolization Coils and Liquid Embolic Agents

One of the most common neuro-interventional procedures is brain aneurysm embolization which involves inserting embolization coils or liquid embolic agents such as Onyx into the aneurysm sac to block blood flow. Detachable platinum coils of various sizes and shapes are routinely used. Advances in coil designs like increased coil flexibility and pushability as well as bioactive coatings have improved their conformability to irregular aneurysm shapes. Liquid embolic agents like Onyx are particularly useful for large or giant aneurysms where traditional coils pose difficulties. Onyx allows for filling of the entire aneurysm sac resulting in improved occlusion rates and stability over time. These modern embolization modalities have significantly reduced risks associated with open surgery and increased treatment success rates for brain aneurysms.

Stents and Balloons

Carotid artery stenting with embolic protection devices is an alternative to carotid endarterectomy for treating carotid artery stenosis to prevent stroke. The stents are precisely deployed via microcatheters to widen the narrowed carotid artery and restore proper blood flow. Balloon expandable and self-expanding stents are available. Balloon angioplasty with or without stenting is also performed for vertebral and intracranial arterial stenosis using very low profile balloons and microcatheters. For acute ischemic strokes caused by large vessel occlusions, mechanical thrombectomy devices along with stent retrievers are showing promising results for recanalization when administered within a few hours of symptom onset.

Neurothrombectomy Devices

Several first-in-human trials have demonstrated the safety and efficacy of novel mechanical thrombectomy devices for ischemic stroke caused by large vessel occlusions. The Solitaire device was among the first FDA approved stent retrievers for such applications. It is a self-expanding retrievable stent designed to restore blood flow by removing thrombi. Other similar devices include Trevo, Catch and MindFrame Captor. Recent studies are showing faster recanalization rates and better clinical outcomes when these stent retrievers are used in combination with aspiration devices like the Penumbra system rather than stent retrieval alone. This has led to increased usage of combined endovascular thrombectomy approaches over the past few years.

Imaging and Navigation

Modern neuro-interventional procedures rely heavily on high resolution imaging such as digital subtraction angiography, CT angiography, MRI angiography and MR perfusion imaging to precisely identify vascular abnormalities, delineate anatomy and guide device placement. Technological upgrades in imaging hardware and advanced imaging processing software have enabled visualization of intracranial vessels down to 1mm in diameter. Patient-specific 3D models and virtual angiography simulations also help pre-procedural planning. Electromagnetic and fiber optic brain navigation systems coupled with microcatheters and guidewires with position sensing capabilities facilitate precise navigation of devices within the brain and spinal cord under real-time imaging guidance.

Future Outlook

As neuro-interventional techniques continue gaining popularity and acceptance, ongoing research is exploring new possibilities. Devices targeted at improving recanalization rates for ischemic strokes caused by distal vessel occlusions are needed. Novel coil designs, bioactive agents, and flow diversion stents hold promise for expanding aneurysm treatment options. Advancements in miniaturization, trackable devices, imaging modalities and navigation systems will further enhance the accuracy and outcomes of these minimally invasive approaches. With growing evidence supporting their benefits, neuro-interventional procedures are set to transform the management algorithm of many intracranial vascular and spinal diseases in the future.

Conclusion

In summary, neuro-interventional devices have revolutionized the treatment landscape for cerebral as well as spinal disorders over the last two decades. Continual technological and procedural innovations are allowing endovascular solutions for an increasing number of neurological conditions previously treated only through open surgeries. As multidisciplinary neuroscience research pushes the boundaries, these minimally invasive techniques hold great potential to further improve patient care and outcomes.

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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