腔内成型术治疗犬顽固性脑血管痉挛

Endovascular therapy for canine refractory cerebral vasospasm in dogs

目的 :探讨单纯球囊或罂粟碱联合球囊介入动脉腔内治疗顽固性脑血管痉挛的可行性和效果 .方法 :成年杂种犬 4 5只 ,脑血管痉挛模型采用枕大池两次注血法 .实验组 4 0只 ,根据痉挛后脑动脉径路的清晰程度的不同 ,采用单纯球囊或罂粟碱联合球囊血管成形术治疗 ;对照组 5只 ,采用静脉内滴注罂粟碱治疗 .2 0d后所有犬复查脑血管造影 ,再次观察疗效 .结果 :4 5只犬的椎基底动脉系统均发生痉挛 .实验组中痉挛椎基底动脉的径路清楚者有 2 7只 ,其中接受球囊成形术治疗 2 0只 ,成功 18只、死亡 2只 ,而另外的 7只犬血管走行极为迂曲 ,无法接受球囊成形术治疗 ;实验组中动脉极度痉挛乃至术区血管路径没有显示者有 13只 ,均接受了罂粟碱联合球囊治疗 ,仅成功 3只 .对照组治疗均无效 .2 0d后复查脑血管造影发现 ,实验组中治疗成功犬的基底动脉显影基本正常 ,而对照组和实验组中未能成功治疗犬的椎基底动脉仍有明显的痉挛 .结论 :血管腔内成形术是治疗顽固性脑血管痉挛的一种可靠和有效的方法 .

AIM: To investigate the efficacy of treating experimental refractory cerebral vasospasm (rCVS) with percutaneous tansluminal angioplasty (PTA) or intra artery papaverine infusion (IAP) plus PTA. METHODS: 45 adult mongrel dogs were sacrificed and 40 were used in experimental group and 5 in the control. Artery spasm was induced by two time blood injection into brain cisterns. In the experiment group, PTA or IAP plus PTA was chosen by the status of vessels. In the control group, papaverine was given through intraveins. RESULTS: Basilar arteries of all the dogs were constricted after the two time blood injection. In the experimental group, 20 dogs were treated by PTA but only 18 succeeded. 13 dogs in the experimental group were treated by IAP plus PTA therapy, but only 3 of them succeeded. In the control group, the spastic arteries of all dogs showed no improvement following the therapy. When re examined 20 days later, the 21 canines treated by either PTA or IAP plus PTA all had normal angiograph, while those of the control group and those who had not successfully had PTA or IAP plus PTA in experiment group had little change. CONCLUSION: PTA is effective treatment of cerebral vasospasm.