Ep. 406 Biodegradable Flow Diverters for Cerebral Aneurysms with Dr. Alim Mitha
01/17/24 • 38 min
In this episode of the Back Table Innovation Podcast, host Dr. Diana Velazquez-Pimentel, a radiologist and biomedical engineer, chats with Dr. Alim Mitha about the novel idea of biodegradable flow diverters and the future of interventional neuroradiology. Dr. Mitha is a cerebrovascular, endovascular, and skull base neurosurgeon and biomedical engineer at the University of Calgary.
During his neurosurgery residency, Dr. Mitha also completed a master’s degree in biomedical engineering. Afterwards, he pursued additional fellowships in cerebrovascular and skull base surgery, as well as endovascular neurosurgery. Since then, he has started a research lab focused on tissue engineering and biomedical device development. He explains the role of flow diverters and how they are used to guide blood flow away from the intracranial aneurysms.
While flow diverters have been applied to treatment of many different types of aneurysms, Dr. Mitha notes that these devices carry thrombogenic risks. During his training, he saw that it was not preferable to deploy a flow diverter in a young patient who would have to remain on antiplatelet therapy for the rest of their life. As a result, Dr. Mitha began to develop a polymer-based biodegradable flow diverter that could be absorbed by the body after the aneurysm had been occluded, in addition to being visible on non-invasive imaging. He explains the process of building a prototype, incorporating a company, joining a start-up incubator, and now performing first in-human-clinical trials.
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CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
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SHOW NOTES
00:00 Introduction
03:05 Understanding the Role of Flow Diverters
08:17 The Conception of a Biodegradable Flow Diverter
11:35 The Challenges and Successes in Prototyping
13:53 A Path Towards Commercialization
16:10 Considerations for Clinical Adoption
24:00 Developing Skills for Engineering and Entrepreneurship
27:29 First-In-Human Trials and Early Feedback
30:36 Innovating Within the University of Calgary
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RESOURCES
University of Calgary Creative Destruction Lab:
https://creativedestructionlab.com/locations/calgary/
The Brain Conferences:
https://www.fens.org/meetings/the-brain-conferences
In this episode of the Back Table Innovation Podcast, host Dr. Diana Velazquez-Pimentel, a radiologist and biomedical engineer, chats with Dr. Alim Mitha about the novel idea of biodegradable flow diverters and the future of interventional neuroradiology. Dr. Mitha is a cerebrovascular, endovascular, and skull base neurosurgeon and biomedical engineer at the University of Calgary.
During his neurosurgery residency, Dr. Mitha also completed a master’s degree in biomedical engineering. Afterwards, he pursued additional fellowships in cerebrovascular and skull base surgery, as well as endovascular neurosurgery. Since then, he has started a research lab focused on tissue engineering and biomedical device development. He explains the role of flow diverters and how they are used to guide blood flow away from the intracranial aneurysms.
While flow diverters have been applied to treatment of many different types of aneurysms, Dr. Mitha notes that these devices carry thrombogenic risks. During his training, he saw that it was not preferable to deploy a flow diverter in a young patient who would have to remain on antiplatelet therapy for the rest of their life. As a result, Dr. Mitha began to develop a polymer-based biodegradable flow diverter that could be absorbed by the body after the aneurysm had been occluded, in addition to being visible on non-invasive imaging. He explains the process of building a prototype, incorporating a company, joining a start-up incubator, and now performing first in-human-clinical trials.
---
CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
---
SHOW NOTES
00:00 Introduction
03:05 Understanding the Role of Flow Diverters
08:17 The Conception of a Biodegradable Flow Diverter
11:35 The Challenges and Successes in Prototyping
13:53 A Path Towards Commercialization
16:10 Considerations for Clinical Adoption
24:00 Developing Skills for Engineering and Entrepreneurship
27:29 First-In-Human Trials and Early Feedback
30:36 Innovating Within the University of Calgary
---
RESOURCES
University of Calgary Creative Destruction Lab:
https://creativedestructionlab.com/locations/calgary/
The Brain Conferences:
https://www.fens.org/meetings/the-brain-conferences
Previous Episode
Ep. 405 Site of Service Differentials with Dr. Michael Cumming
In this episode of the BackTable Podcast, host Dr. Ally Baheti interviews Dr. Michael Cumming about the issue of site of service differentials in healthcare. Dr. Cumming is an interventional radiologist and the founder of Vascular and Interventional Experts.
They discuss the history and the impact of these differentials, which often result in higher costs for identical services depending on the site they’re carried out in. For example, services offered within hospitals typically cost significantly more than those offered in ambulatory surgery centers or physician offices. The doctors also describe the role of key stakeholders such as lobbyists and industry players, the outcomes of care provided in various settings, and ongoing legislative efforts to address these issues. Finally, they discuss how physicians can advocate for high quality, value-based care.
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CHECK OUT OUR SPONSORS
Siemens Healthineers
https://www.siemens-healthineers.com/
Varian, a Siemens Healthineers company
https://www.varian.com/products/interventional-solutions/embolization-solutions
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SHOW NOTES
00:00 - Introduction
03:33 - Site of Service and Its Impact on Payment
06:15 - Role of CMS in Determining Payment
09:09 - Role of Advocacy Groups in Site of Service Payments
17:51 - Future of Site of Service Payments
20:17 - Negative Consequences of Site of Service Differentials
24:01 - Closing Remarks and Reflections
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RESOURCES
CMS.gov website:
https://www.cms.gov/
Preliminary Results of the Outpatient Endovascular and Interventional Society National Registry:
https://journals.sagepub.com/doi/10.1177/1526602820949970
Next Episode
Ep. 407 The Evolving Role of Drug Eluting Stents in PAD with Dr. Eric Secemsky
In this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews Dr. Eric Secemsky about the efficacy of drug eluting technologies in vascular interventions, with Dr. Secemsky offering insight into his own practice. Dr. Secemsky is an interventional cardiologist practicing at Beth Israel Deaconess Medical Center in Boston.
Dr. Secemsky believes that drug coated technology is a game-changer in the endovascular space since it improves patient outcomes by reducing the risk of needing additional procedures. Dr. Secemsky highlights the importance of various trials such as IMPERIAL and EMINENT, which compare the effectiveness of different stents. He also speaks about the significance of the Cook Medical prediction model to calculate intervention success rates and the role of disease site-specific interventions. Dr. Secemsky ends the podcast by sharing his thoughts about advancements in the near future, including the use of bioabsorbable stents and sirolimus drug-coated balloons.
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CHECK OUT OUR SPONSOR
Cook Medical Zilver PTX
https://www.cookmedical.com/zilverptxbacktable
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SHOW NOTES
00:00 - Introduction
09:31 - Understanding Drug Coated Balloons and Stents
14:29 - The Paclitaxel Controversy
19:30 - Stenting Algorithm for Fem-Pop Disease
23:55 - Impact of Lithotripsy on Drug Delivery
26:02 - Predictability Models for Revascularization
29:14 - Economic Considerations in Drug Eluting Stent Usage
31:33 - Highlighting Trials on Drug Coated Technology and Drug Eluting Stents
37:08 - Future Technologies: Drug on Stent Grafts and Spot Stenting
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RESOURCES
Zilver PTX Cook Prediction Model:
https://cooksfa.z13.web.core.windows.net/
Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials:
https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011245
Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal Artery: 5-Year Results of the Zilver PTX Randomized Trial:
https://pubmed.ncbi.nlm.nih.gov/26969758/
Mortality in randomized controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02189-X/fulltext
Outcomes of Stented vs Nonstented Femoropopliteal Lesions Treated With Drug-Coated Balloon Angioplasty:
https://pubmed.ncbi.nlm.nih.gov/35179065/
Drug coated balloon improves outcomes of sub-optimal Supera deployment in the intermediate term:
https://pubmed.ncbi.nlm.nih.gov/36494491/
Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency: Twelve-Month Results of the DEFINITIVE AR Study:
https://pubmed.ncbi.nlm.nih.gov/28916599/
Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial:
https://pubmed.ncbi.nlm.nih.gov/34167675/
Efficacy of a Drug-Eluting Stent Versus Bare Metal Stents for Symptomatic Femoropopliteal Peripheral Artery Disease: Primary Results of the EMINENT Randomized Trial:
https://pubmed.ncbi.nlm.nih.gov/36254728/
A polymer-coated, paclitaxel-eluting stent (Eluvia) versus a polymer-free, paclitaxel-coated stent (Zilver PTX) for endovascular femoropopliteal intervention (IMPERIAL): a randomized, non-inferiority trial:
https://doi.org/10.1016/S0140-6736(18)32262-1
SPORTS Clinical Trial Results Boston Scientific:
https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/drug-eluting-stent-drug-coated-balloon/eluvia/sports-rct.html
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