生物医学新材料为颅内动脉瘤血管内治疗带来的前景与优势

Novel biomedical materials for endovascular treatment of intracranial aneurysms:Prospect and superiority

学术背景:血管内介入治疗动脉瘤使患者死亡率明显降低,且依从性好,但仍存在动脉瘤再通、对于宽颈及较大和巨大动脉瘤不能有效和持续栓塞的问题,近年来开展的脑血管内组织工程为弥补上述不足提供了新思路。目的:介绍颅内动脉瘤血管内介入治疗材料的研究进展及其使用方法。检索策略:由第一、二作者应用计算机检索Pubmed数据库1992-01/2007-02相关文献,检索词为"intracranial aneurysm endovascular treatment"限定语言种类为"English";同时检索维普中文期刊数据库、万方数据库1995-01/2007-02相关文献,检索词为"颅内动脉瘤血管内介入治疗",限定语言种类为中文;同时手工翻阅相关书籍。纳入标准:文章内容与颅内动脉瘤血管内介入治疗新材料的特点及进展有关。排除标准:较陈旧的文献和重复研究。文献评价:共收集到65篇相关文献,29篇文献符合标准,其中3篇为综述和述评类文献,其余26篇为基础研究。29篇中9篇介绍新材料的生物学特性,20篇是关于新材料在颅内动脉瘤血管内介入治疗领域中的应用。资料综合:重点介绍了新型颅内血管支架Neuroform支架、3-D微弹簧圈、Tispan技术、Matrix微弹簧圈、非黏附性液体栓塞材料ONYX、TRUFILL DCS可脱性弹簧圈系统、可膨胀性水凝胶-铂金弹簧圈HES等新材料的发展和改进过程,各种新材料的特性和优缺点,以及新材料在颅内动脉瘤血管内介入治疗领域中的应用情况和发展趋势。结论:脑血管疾病血管内治疗所用组织工程弹簧圈和组织工程支架,有的处在动物实验或临床前期研究阶段,有的已应用到临床,并取得了良好的效果。组织工程弹簧圈将逐步取代铂金弹簧圈,以实现动脉瘤良好的长期填塞效果。

BACKGROUND： Endovascular interventional treatment can obviously reduce the mortality of the patients with intracranial aneurysms and present good compliance, but it also induces aneurysm recanalization and is ineffective for the occlusion in patients with wide-necked, large or huge aneurysms. And the recent cerebrovascular tissue engineering provides the novel approach for making up these deficiencies. OBJECTIVE： To introduce the research progress and application of the materials for endovascular treatment of intracranial aneurysms. RETRIEVE STRATEGY： A computer-based search of Pubmed database was undertaken by the first and the second authors to identify the articles between January lgg2 and February 2007, with the key words of ＂intracranial aneurysm endovascular treatment＂ in English. Meanwhile the Weipu Chinese Journal Database and Wanfang Database were retrieved for the related articles published from January 1995 to February 2007 by the key words of ＂endovascular treatment for intracranial aneurysm＂ in Chinese. Additionally the relevant books were checked manually. Inclusive criteria： the articles related to the characteristics and progress on the novel materials of endovascular treatment for intracranial aneurysm. Exclusive criteria： outdated and repeated researches. LITERATURE EVALUATION： A total of 65 articles ware collected, and 29 of them were in accordance with the inclusive criteria, including 3 reviews and 26 basic searches. Among the included articles, g ones referred to the biological property of the novel materials, and 20 ones involved in the application of the novel materials in the endovascular treatment for intracranial aneurysm. DATA SYNTHESIS： The novel materials consist of intracranial Neuroform stent, 3-D coils, Tispan technique, Matrix coils, liquid polymer material ONYX, TRUFILL DCS detachable coils, expandable gel-platinum coils and so on. This paper introduces the progress and modification of these material, the characteristics, merit and shortcoming of each material, as well as the application and development of the novel materials in the endovascular treatment for intracranial aneurysm. CONCLUSION： Some of tissue engineered coils and stents in the endovascular treatment for intracranial aneurysm are investigated in the animal experiments or early stage in clinics, while some have been applied in clinics with good outcomes. Tissue engineered coils is superior to platinum coils for the long-term occlusion of aneurysm.