支架结合弹簧圈栓塞梭形动脉瘤的实验研究

Combined Stent and Coil in Endovascular Treatment of Fusiform Aneurysms

目的:评价支架结合游离钨丝弹簧圈(FTC)进行血管内治疗的有效性、安全性和可行性,为临床应用提供依据。方法:取12只家犬,全麻成功后,截取一段颈静脉,应用显微外科手术将其两端与横断的两侧颈动脉行端端吻合,共制作颈动脉梭形动脉瘤模型24个。将24个梭形动脉瘤随机分为实验组和对照组。实验组的梭形动脉瘤用支架和国产游离钨丝弹簧圈进行血管内栓塞,对照组不行任何处理。分别于术后即刻及6个月行数字减影血管造影(DSA)观察,并于6个月后取动脉瘤标本进行病理学观察,评估治疗效果。结果:实验组DSA示载瘤动脉通畅,梭形动脉瘤完全消失;病理示动脉瘤内血栓形成完全,动脉瘤口及支架上有透明膜覆盖。对照组DSA示载瘤动脉通畅,6个月时梭形动脉瘤明显扩大,内壁不规则。病理见动脉瘤内有血栓形成。两组均无动脉瘤破裂发生。结论:支架结合弹簧圈治疗梭形动脉瘤方法简单,疗效肯定,可以作为传统手术治疗的替代方法。

Objective： To study the effectiveness, reliability and feasibility of endovascular occlusion in fusiform aneurysm （FA） using stent and free microcoils （FMC） in dogs. Methods： This study included 12 dogs. After general anesthesia, a segment of jugular vein was intercepted, which was sewed up end-to-end microsurgically to the two ends of the transected carotid arteries on the two sides. All FAs were divided into two groups randomly： interventional group and control group. Stents were placed endovascularly along the lengths of experimentally created FAs. FMCs were then pushed into the lumen through the mesh of the stent. Digital subtraction angiography （DSA） follow-up was used to evaluate the occlusion effectiveness immediately after the embolization and at the 6 months postembolization. Histopathologic examination was used to assess the growth of endoepithelial cells at the neck of FAs and on the stents. Results： All FAs disappeared completely after 6 months in the experimental group. Histopathologic analysis revealed fibrotic reactive scar tissue covering the stent wires, coils and outer wall of the fusiform aneurysm. The FAs enlarged after 6 months in control group, No rupture of FAs was found in both groups, Conclusion： Stent and coils could be used to treat experimental FAs. The endovascular method may be better in the therapy of the FAs than the traditional operative method.