Willis覆膜支架植入犬颈动脉梭形动脉瘤模型中远期随访观察

The implantation of Willis covered stent for the treatment of carotid fusiform aneurysms in canine models: mid-to-long-term follow-up observation

目的建立犬颈动脉梭形动脉瘤模型,植入 Willis 覆膜支架,评价其治疗作用。方法静脉囊移植法构建梭形动脉瘤模型,建模后 4 周植入 Willis 覆膜支架。支架植入后即刻,2 周,1、3、6、9、12、15个月分别随访血管造影,评价治疗有效性。组织病理学检查动脉瘤标本,观察其内皮化过程。结果成功构建 28 枚梭形动脉瘤模型,植入 56 枚 Willis 支架,即刻血管造影显示动脉瘤模型完全闭塞 23 枚,存有内漏 5 枚。随访 2 周时血管造影新出现内漏 2 枚。除了Ⅲ型内漏外,后续随访期间内漏逐渐减少,直至消失。治疗有效率为 92.9%(26/28)。组织病理学检查显示内皮细胞在 15 个月时成熟并规律排列。结论Willis 覆膜支架植入是治疗犬颈动脉梭形动脉瘤模型的有效方法。与直段血管相比,该模型中内皮化时间延长。

Objective To establish carotid fusiform aneurysm model in canine, and to evaluate the therapeutic effect of Willis covered stent implantation for the aneurysm. Methods Venous sac transplantation method was used to establish the fusiform aneurysm model in canine. Four weeks after modeling , implantation of Willis covered stent was performed in all experimental dogs. Two weeks as well as 1, 3, 6, 9, 12 and 15 months after treatment follow- up angiography was performed to evaluate the therapeutic effectiveness. Aneurysm specimens were collected for histopathological examination to observe its endothelialization process. Results A total of 28 fusiform aneurysms were successfully created, and a total of 56 covered stents were implanted successfully. Angiography performed immediately after procedure showed that complete occlusion of aneurysm was obtained in 23 models and endoleak was detected in 5 models. Follow- up angiography after 2 weeks revealed that there were 2 newly - developed endoleaks. The number of endoleaks, except type Ⅲ of endoleak, gradually decreased during the follow- up period till all endoleaks disappeared. The effective rate was 92.9%(26/28). Histopathological examination indicated that 15 months after treatment the endothelial cells became matured and were regularly arranged. Conclusion For the treatment of carotid fusiform aneurysm of canine model, Willis stent implantation is an effective method. The endothelialization process in this model takes a longer time than that in a straight vessel.