Mechanism of delayed intrasaccular device changes

Determine the mechanisms responsible for slower post-treatment changes in the shape and position of intrasaccular aneurysm implants, including the respective contributions of pulsatile loading, wall motion, inter-wire slip, evolving thrombus, and tissue healing, and compare predicted changes with longitudinal imaging.

Background

The review explains that the device–ostium interface of intrasaccular implants can evolve after treatment. Although initial coverage may reduce inflow and promote thrombus organization and tissue healing, later deformation or displacement can reduce coverage and reopen preferential inflow pathways, potentially contributing to recurrence.

Longitudinal studies have documented changes in the shape and position of WEB and CNS devices, including complete inversion of a CNS device. The authors distinguish this observed behavior from the less well-understood mechanisms governing slower changes over time. They identify pulsatile loading, wall motion, inter-wire slip, evolving thrombus, and tissue healing as possible contributors and emphasize that long-term predictions should remain prospective until validated against longitudinal imaging.