超声消融联合球囊扩张治疗闭塞性动脉硬化病变的实验研究

Experimental Study of Intravascular Ultrasound Ablation Combined with Balloon Angioplasty in the Treatment of Peripheral Arterial Occlusion Lesions

目的 评价血管内超声消融术治疗异种移植的人体完全闭塞性动脉硬化病变的有效性和安全性。方法 11例人体完全闭塞的硬化动脉段异种移植于 6条实验犬的口径匹配的动脉上 ,并进行超声消融治疗。比较消融治疗和部分合并球囊扩张前后移植动脉的狭窄度和远端动脉血流量变化 ,并测算相应操作后移植血管的损伤系数。结果 11例完全闭塞动脉段经超声消融后 ,10例血管再通 ,单位长度消融率为 (72± 2 8)s/cm。超声消融后血管狭窄度由 10 0 %降至 (72± 15 ) % ,P <0 .0 1,无动脉夹层、穿孔和远端栓塞表现 ;合并球囊扩张后狭窄度降至 (4 1± 14 ) % ,P <0 .0 1。结论 血管内超声消融术可为完全闭塞的动脉建立新的血流通道 ,联合其他腔内介入技术可显著改善闭塞血管的通畅性 ;对正常血管壁损伤极小 。

Purpose: To evaluate the effectiveness and safety of intravascular ultrasound angioplasty in the recanalization of occluded thrombotic or atherosclerotic arteries in animal models. Methods: A total of 11 completely occluded segments of human atherosclerotic arteries were surgically implanted in the diameter-matched arteries of 6 dogs. Intravascular ultrasound was performed to recanalize the occluded xenograft. The changes of stenotic degree of grafts and blood flow in the distal femoral arteries were measured before and after the ultrasound intervention and again after combined balloon angioplasty. Arterial injury index was evaluated by postmortem histological examination. Results: Ten of eleven occluded xenografts were recanalized after ultrasound ablation with a ablation rate of (72±28) s/cm, eight of the ten vessels underwent balloon angioplasty to increase the arterial lumen area. Angiographic residual stenosis of the complete occlusions with ultrasound recanalization alone was (72±15) % (P<0.01); when ultrasound recanalization was combined with balloon angioplasty, the residual stenosis was (41±14) % (P<0.01). No presence of dissection, perforation, and distal embolization was noted on angiogram film after ultrasound ablation. Conclusions: Ultrasound angioplasty has a potential to reopen completely obstructed atherosclerotic vessels with a small new channel with minimal damage to the normal arterial wall, allowing to achieve satisfactory reperfusion with adjuctive intervention techniques.