聚氨脂栓塞脑动静脉畸形的动物实验研究

Polyaminoester (PA) for embolization of cerebral arteriovenous malformations: an experimental study.

目的 探讨新型栓塞材料聚氨酯（PA）栓塞脑动静脉畸形（AVM）的可行性,评价其引起的病理改变。方法 体外实验测定PA/DMSO的物理性质如沉淀时间、粘质度和密度等。体内实验以猪自然存在的颅底血管网（RMB）为AVM的模型。PA/DMSO溶液栓塞后不同时期行脑血管造影复查,并获取标本行光镜检查。结果 在20℃和37℃条件下,实验所用PA/DMRO溶液的沉淀时间分别为（13.50±0.150）s和（13.48±0.143）s（P>0.05）,温度对其无影响。PA栓塞后动物无不良临床反应或死亡。通过微导管注射PA/DMSO无困难,未发生微导管粘附于血管壁的情况,PA在RMB内的弥散和铸型良好。造影复查未见血管再通。主要病理改变为血管内弹力层的断裂或消失以及炎性反应。结论 PA作为非粘附性液体栓塞材料可达到永久栓塞的目的。其病理反应不引起不良症状,临床上可以接受。为较理想的AVM的栓塞材料。

Objective To study the feasibility and safety of embolization of AVM with PA in swine models and to evaluate the histopathological changes. Methods By in vitro study, the physical characteristics of PA/DMSO were examined. In vivo study, swine rete mirabiles(RMBs) were used as AVM models for the PA embolization. Angiographic and histopathological evaluations were made in different periods after the embolization procedure. Results The precipitating time at 20℃ and 37℃ were (13.50± 0.150) and (13.48 ± 0.143) s (P > 0.05) respectively. There was no difficulty in delivering PA/DMSO mixture through the microcatheter and no occurrence of catheter ' gluing' . The mixture could well diffuse into the RMB and form a cast. There was no angiographic recanalization at follow-up. The major pathological changes were the disruption or disappearance of internal lamina elstica and scattered inflammation response manifested by the foreign body giant cell reaction. Conclusions PA/ DMSO mixture can achieve permanent occlusion of swine RMB with pathological changes that are clinically acceptable. It seems to be an excellent liquid nonadhensive embolic material in the treatment of cerebral arteriovenous malformations.