摘要
目的探讨2种覆膜支架即聚氨酯膜支架(PUM-SSS)和生物膜支架(BM-SSS)治疗颅颈部囊状动脉瘤的可行性。方法16条健康杂种犬共成功建立颈部囊状侧壁动脉瘤模型29个,其中26个应用血管内技术成功放置14枚BM-SSS(BM-SSS组)和12枚PUM-SSS(PUM-SSS组),另外3个不予任何处理作为对照组。支架置入后即刻及术后2、4、12周分别进行血管造影随访,不同随访时间结束后,进行组织病理学检查,最后进行统计学分析。结果血管造影显示,支架置入后即刻所有动脉瘤瘤腔全部消失,载瘤动脉保持通畅。对照组在直至1年的随访中动脉瘤瘤腔及载瘤动脉均显影良好。在置放的14枚生物膜支架及12枚聚氨酯膜支架中,分别有13枚和3枚开放良好,两者完全开放率比较差异有统计学意义(采用Fisher确切概率计算法,P=0.0008)。组织学分析表明,支架置放后12周2种支架的内皮化基本完成,所有治疗的动脉瘤瘤腔内均见血栓及纤维组织充填,支架深嵌于载瘤动脉血管壁内,表面被新生的内膜所覆盖。2种支架所在处血管均有不同程度的细胞变性。结论覆膜支架是1种新的简单、安全、有效的治疗颅颈部动脉瘤的方法。生物膜支架是1种较理想的覆膜支架,而聚氨酯膜支架在应用于临床前尚需做进一步的研究。
Objective To assess the effectiveness and biocompatibility of balloon-expanding, stainless steel stents covered with biomembrane （BM-SSS） and polyurethane membrane （PUM-SSS） in the treatment of experimental saccular aneurysms in a canine model and to observe the ablation of aneurysm with preservation of the parent vessel. Methods Sixteen healthy mongrel canines were included in our study. 26 of 29 successful experimental aneurysms were treated with covered stents, another 3 were untreated to serve as controls. Altogether there were fourteen BM-SSS and twelve PUM-SSS were placed endovascularly in the common carotid arteries covering the orifice of the aneurysms. Control angiography was performed immediately after the procedure and after 2 weeks, 4 weeks and 12 weeks. According to grouping time, each aneurysm together with stented arteries was removed with animals alive for histopathological examination. Enumeration data was analyzed by Fisher＇s Exact Test using SPSS 10. 0. Results Before stent placement, angiography of the common carotid arteries showed round, saccular side-wall aneurysms and complex pattern of flow. Immediately after stent placement the aneurysmal pouches were no longer visible and the stented common carotid arteries remained widely patent. All controlled aneurysms and common carotid arteries have been patent and unchanged for 1 year. 13 of 14 stented common carotid arteries with BM-SSS and 3 of 12 with PUM-SSS remained widely patent. The complete patency rate of BM-SSS and PUM-SSS was sit^nificantly different （ P = 0. 0008 ）. Histological analysis indicated that all treated aneurysmal pouches were almost filled with thrombus, as well as with fibrotic reactive scar tissue. Stent wires were found to be located deep within the vessel wall and encased by an extension of the tunica intima. The endothelium of the two groups was already mature at 12 weeks, and various degree of degenerate cells were seen under the transmission electron microscopy. Conclusion Placement of covered stent endovascularly is proved expedient, effective. BM-SSS has better mechanical behavior, physiochemical stability, anticoagulative biocompatibility than PUM-SSS, and PUM-SSS is not fit for clinical application at present.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2006年第2期149-154,共6页
Chinese Journal of Radiology
基金
上海市优秀学科带头人基金资助项目(200020)
关键词
动脉瘤
颈动脉
支架
动物
实验
组织学
比较
Aneurysm
Carotid arteries
Stents
Animals laboratory
comparative safe, and ability and Histology,
