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Dr. Barleben used our Mock Flow Loop to test a novel endovascular deployment method. Our experiment showed that the following stent deployment sequence will not interrupt blood flow to the brain when performed in the following sequence:
1. Stent graft advancement over a stiff wire into the arch (Cook Thoracic Grafts - Zenith Alpha)
2. Unsheathing the graft into its partially deployed state
3. Creating a fenestration in the graft for the occluded artery using the Reflow Wingman (sharp-tipped catheter) along with a steerable sheath (Medtronic)
4. Wiring the affected artery from the fenestration
5. Ballooning the fenestration (with a balloon 1/2 the diameter of the target vessel)
6. Ballooning the aortic graft to break the constraints
7. Delivering and stenting the artery fenestration with a PTFE-covered balloon expandable stent (Gore VBX)
In this protocol, steps 3-7 can take a long time-in our case over an hour. This is the period of concern in which we wanted to ensure that blood flow to the brain is uninterrupted.Â
All of the devices used above are intentionally used for other purposes but have been repurposed for our experiment. All of them could be redesigned and optimized for this delivery schema or we could potentially create a specialized device system for this procedure using the information from this experiment.
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