血管内机械取栓过程中Solitaire支架对血管内膜损伤实验研究

Damage effect of Solitaire stent on tunica intima during thrombectomy

目的探讨血管内机械取栓过程中Solitaire支架对血管内膜的损伤作用,以评价血管内机械取栓的安全性。方法共12只健康雄性新西兰兔成功制备血管内机械取栓模型,随机分为4组(每组各3只计6侧),对照组仅置入微导管而未释放支架,第一取栓组、第二取栓组和第三取栓组分别于同一部位模拟血管内机械取栓1、3和5次。术后即刻切取双侧颈动脉,行HE染色和超微结构观察,采用半定量分析评价颈动脉损伤程度。结果动物模型制备过程中,DSA显示血管壁直径2.10~2.90 mm,未见血管痉挛、出血、穿孔和动脉夹层,均模型制备成功。不同处理组颈动脉损伤程度比较,差异有统计学意义(F=119.108,P=0.000),其中,3个取栓组颈动脉损伤程度均重于对照组(q=3.136,P=0.001;q=7.463,P=0.000;q=10.682,P=0.000),第二取栓组和第三取栓组均重于第一取栓组(q=3.330,P=0.000;q=8.160,P=0.000),第三取栓组亦重于第二取栓组(q=4.830,P=0.000)。光学显微镜观察,随着血管内机械取栓次数的增加,颈动脉内膜损伤范围更广泛、损伤后颈动脉内膜反应更严重;扫描电子显微镜观察,随着血管内机械取栓次数的增加,颈动脉损伤深度增加。结论血管内机械取栓过程中Solitaire支架可能损伤血管,且随着取栓次数的增加,血管损伤程度加重。

Objective To discuss the damage effect of Solitaire stent on tunica intima during thrombectomy, so as to evaluate the safety of thrombectomy. Methods Twelve healthy male New Zealand rabbits were randomly divided into 4 groups（3 rabbits in each group）, including control group and 3 thrombectomy groups. Microcatheter was used instead of stent in control group. The other 3 groups underwent mimic thrombectomy for 1, 3 and 5 times in the same position, respectively. The procedure was performed at both sides of carotid artery of each rabbit. Immediately after operation, bilateral carotid arteries of each rabbit were removed, performed HE staining and examined the ultrastructure under microscope. Semi.quantitative analysis was used to evaluate the damage of carotid artery. Results During the model preparation, DSA showed the diameter of vascular wall was 2.10-2.90 mm, and there was no vascular spasm, bleeding, perforation or arterial dissection. Therefore, the model was successfully established. The difference of carotid artery damage among different groups was statistically significant（F =119.108, P=0.000）. Compared with control group, the carotid artery damage of 3 thrombectomy groups was more serious（q=3.136, P=0.001; q=7.463, P=0.000; q=10.682, P=0.000）. The carotid artery damage of the second and third thrombectomy group was more serious than the first group（q=3.330, P=0.000; q =8.160, P=0.000）. The carotid artery damage of the third thrombectomy group was more serious than the second group（q=4.830, P=0.000）. Optical microscope observation showed that with the increase of times of thrombectomy, carotid intimal injury was more extensive and intimal reaction was more severe. Scanning electron microscopy showed that with the increase of times of thrombectomy, the degree of carotid artery injury was increased. Conclusions Solitaire stent may injure tunica intima, and with the increase of times of thrombectomy, the damage to vascular wall will increase.