局部密网血流转向支架治疗兔侧壁型囊状动脉瘤

The occlusion of lateral aneurysm in common carotid artery of rabbit by flow-diverting stent

目的 探讨局部密网血流转向支架治疗兔侧壁型囊状动脉瘤的可行性.方法 10只家兔成功建立侧壁型动脉瘤9个,其中6个作为实验组置入局部密网血流转向支架,支架置入术后立即及术后28 d分别进行造影随访,并行病理学检查;另外3个动脉瘤作为对照组不置入支架,于建模成功后立即及术后28 d分别进行造影随访,并行病理学检查.结果 实验组6个动脉瘤支架置入术后均即刻动脉瘤腔显影,造影剂在腔内滞留时间延长,流速变慢,未见涡流,载瘤动脉通畅无狭窄,支架位置准确;支架置入术后28 d动脉瘤腔闭塞,支架无移位,载瘤动脉通畅无狭窄;病理检查示支架置入术后28 d支架的内皮化基本完成,动脉瘤腔内均有血栓及纤维组织充填,支架嵌于载瘤动脉血管壁内,表面被新生内膜覆盖.而对照组兔3个动脉瘤无变化.结论 局部密网血流转向支架治疗动脉瘤简单、安全、有效.

Objective To assess the feasibility of flow-diverting stent in the treatment of lateral aneurysm models in common carotid artery of rabbits.Methods Ten rabbits were included in our study.Six of 9 successful experimental aneurysms were treated by flow-diverting stents,and the rest 3 aneurysms were untreated as controls.Angiography was performed immediately and 28 days after the procedure.Aneurysm and stented arteries were removed for histopathological examination.Results In experimental group,before stent placement the angiography of the common artery showed round saccular side-wall aneurysms and complex pattern of flow.Immediatrly after stent placement the aneurysms were still visble and the stented common carotid arteryies remained patent,but the time for the contrast agent in the aneurysm was longer,the complex pattern of flow disappeared.At 28th day after stent placement the aneurysms were no longer visble and the stented common carotid arteryies remained widely patent.All controlled aneurysms and common carotid arteries have been patent and unchanged for 28 days.Histological analysis indicated that all treated aneurismal pouches were almost filled with thrombus as well as fibrotic reactive scar tissue.Stent wires were found to be located within the vessel wall and encased by an extension of the tunica intima.The endothelium was almost mature at 28th day,and various degrees sof degenerative cells were seen under the transmission electron microscopy.Conclusion The occlusion of lateral aneurysm in common carotid artery of rabbits by flow-diverting stent is safe and effective.