非粘管温敏性液体栓塞材料栓塞猪颅底血管网的初步研究

A new remosensitive nonadhensive liquid embolic material,POLY(NIP-co-NNP),in the embolization of rete mirabile:a preliminary exprerimental study

目的:评价非粘管性温敏性液体栓塞材料,聚(N-异丙基丙烯酰氨-co-N-正丙基丙烯酰氨〔Poly(N-isopropylacry-lamide-co-N-n-propylacrylamide),聚(NIP-co-NNP)〕,栓塞猪颅底血管网(rete mirabile,REM)作为脑动静脉畸形(CAVM)模型的可行性;建立通过微导管注射非粘管性温敏栓塞材料的程序;初步评价栓塞效果及REM病理改变。方法:选家猪为试验动物,共35头。栓塞前行猪REM及相连动脉DSA检查。微导管超选择进入REM,注射聚(NIP-co-NNP)水溶胶直到REM完全不显影为止;另侧注射生理盐水对照;3h后再行血管造影。REM在内脑组织经10%福尔马林固定,恒温箱中37℃恒温保存,待组织学检查。结果:置管检查家猪35头,成功33头。栓塞前血管造影33头猪的REM清晰显影;栓塞后血管造影显示栓塞侧33头猪的REM不再显影,注入生理盐水侧REM无变化;未发生微导管头端与栓塞剂相粘连的情况;栓塞术中及术后未发生动物抽搐、偏瘫;组织学检查:大体观察,水溶胶在REM内均匀弥散,REM栓塞完全,与对侧相比较,质地较硬。光镜检查:REM管腔内红细胞均消失,管壁内膜清晰可见,平滑肌层完整。未见剥脱和血管壁的坏死,血管周围未见炎性反应;栓塞REM效果统计,使用卡方的确切概率法,P<0.001。结论:聚(NIP-co-NNP)不粘管、栓塞REM完全、近期无毒性、易通过不同规格的微导管。初步研究表明非粘管性温敏栓塞材料在临床上使用是可行的,为较理想的治疗CAVM的栓塞材料。

Objective：To study the feasibility and safety in the embolizafion of swine rete mirabile （REM） as cerebral arteriovenous malformation （CAVM） models with Poly（N-isopropylaerylamide-co-N-n-propylacrylamide）, Poly（NIP-co-NNP）. To observe the acute histopathological chonges induced by poly（NIP-eo-NNP） and to develop techniques for endovascular delivery of poly（NIP-co-NNP） through microcatheters into swine rete mirabile. Methods： Thirty-five swine were used as animal models in this study. Common carotid artery was catheterized with a 4F/5F Cobra guiding catheter for angiography. Then, a Prowler 14 microcatheter was introduced into the ascending pharyngeal artery coaxiaUy via the guiding catheter, with its tip located just proximal to the REM. Poly（NIP-CO-NNP） was delivered as follows： after superselective angiography, rete mirabile was to be embolizated in the side by Poly（NIP-eo-NNP） through microcatheter with injection rate of 0.6 - 1 ml/s and the total dose of 1.5 - 3.0 ml. The 0.5 ml saline was injected into REM of another side as contrast. Angiography was arranged to determine whether the REM was totally occluded. If not, more Poly（NIP-CO-NNP） was delivered as described above until complete occlusion was achieved. The acute histopathological evaluations of REM was made after operation. Results：Thirty three of thirty five animals were successful to be embolized, where as two failure due to the hyperkinesia and thrombus of blood vessel. All the ascending pharyngeal artery,accipital artery, REM and internal carotid artery （ICA） were clearly visualized by the DSA before embolization. After emholization, angiography confirmed complete REM obliteration in embolized side of all eases, and all the internal carotid artery （ICA） of tirty-drree eases and part ascending pharyngeal artery of twenty six eases could not be showed in the same side in DSA. There were no obvious angiography image changes in the side to be injected with saline. Fisher＇ s exact test of statistics of the REM emholized results was used and P 〈 0.001; ② There was no difficulty in delivering poly（NIP-CO-NNP） through the micro- catheter and no occurrence of catheter ＂gluing＂; ③ Clinical responses to poly（NIP-CO-NNP） emholization were follow-up： No animals died and all survived well and no twitch arid extremity paresis occurred during and after procedure; ④ Acute histopathological results gross inspection： the ascending pharyngeal artery, REM and internal carotid were clearly visualized as DSA showed. The texture was harder in embolized side than in normal side in general specimens. The REM were easily peeled off from cranal fossa. The uniformity dispersion of Poly（NIP-eo-NNP） with gelatinoid and complete obliteration of REM had been shown in all cases. Light microscopic examinations： the disappearance of erythrocyte in the the arterial lumens of REM presented that the lmnens of REM were totally occluded without arterial wall angionecrosis. There was no evidence of an acute cellular inflammatory response or hemorrhage in the perivascular spaces. Conclusion： This study shows Poly（ NiP-co- NNP）, as a new thermosensitive nonadhensive liquid Embolic materials, can diffuse well into the swine REM and achive occlusion of swine REM safely and effectively. Its advantages of Poly（NIP-co-NNP） are non-acute toxicity and non-acute harmful pathological changes, without untoward clinical effects and without untoward catheter ＂gluing＂.