What is the clinical evidence from this study?

Study design: Other. Population: Device-related thrombosis in left atrial appendage occlusion. Intervention: Drop-shaped microgrooves vs. Flat surfaces and parallel microgrooves. Primary outcome: Endothelialization and tissue coverage (e.g., vWF positive area, collagen density).

February 24, 2025Nature Communications11 citationsOpen Access

Drop-shaped microgrooves guide unidirectional cell migration for enhanced endothelialization

XWXing‐Wang Wang CYChenxing Ye QTQian Tang

Key Result

Drop-shaped microgrooves on left atrial appendage occluders guided unidirectional cell migration and significantly accelerated surface endothelialization and tissue coverage in a canine model compared to flat surfaces.

Structured PICO

Does integrating drop-shaped microgrooves into LAA occluders improve endothelialization in preclinical models?

Population

In vitro cell cultures, a rat wound healing model, and a canine left atrial appendage occlusion model used to evaluate the effects of surface microgrooves on endothelialization.

Intervention

Left atrial appendage (LAA) occluder discs integrated with continuous drop-shaped microgrooves

Outcome

Endothelialization and wound healingsurrogate

Integrating drop-shaped microgrooves into LAA occluders promotes rapid endothelialization in preclinical models, offering a potential strategy to reduce device-related thrombosis.

Limitations

In vitro cell migration experiments were carried out in a static environment, which does not simulate the complex turbulent blood flow in the left atrial appendage.
The impact of the designed microgrooves on early thrombosis and inflammation remains unclear.
Transferability of findings to ball-type LAA occluders is uncertain since the study used a disk-type occluder.
Residual shunts or gaps between the occluder and LAA wall may prevent endothelial cells from contacting the microgrooves, leading to incomplete endothelialization.

Abstract

Atrial fibrillation (AF) significantly increases the risk of ischemic stroke, and in non-valvular AF, 90% of stroke-causing thrombi arise from the left atrial appendage (LAA). Percutaneous LAA occlusion using an occluder is a crucial clinical intervention. However, occluder materials could provoke thrombi, termed device-related thrombosis (DRT), leading to treatment failure. Rapid endothelialization is essential to address the DRT but the occluder’s large surface area and irregular cell migration on the surface impede this process. Here, we report a continuous drop-shaped microgroove, which has a drop-shaped unit structure similar to endothelial cells. The microgrooves polarize the cytoskeleton, guiding cell unidirectional migration within the grooves, and increase cell migration efficiency. We show that drop-shaped microgrooves accelerate wound healing in a rat model, and that occluder discs with drop-shaped microgrooves promote endothelialization in a canine model. Together, our results show that integrating microgrooves with medical devices is a promising approach for addressing DRT. Endothelialization of the left atrial appendage (LAA) occluder is vital in addressing device-related thrombosis. Here, the authors report LAA occluders integrated with drop-shaped microgrooves to guide unidirectional cell migration for enhanced endothelialization.

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