摘要
目的探究动脉内微导丝电凝治疗动脉瘤的疗效和安全性问题。方法(1)取临床用于血管内治疗颅内动脉瘤的微导丝SilverSpeed,以抗凝的新西兰大白兔离体动脉血液为介质进行体外电解产气实验,扫描电镜观察微导丝表面的血栓附着情况。(2)使用静脉袋移植法制作兔颈总动脉动脉瘤模型,将动脉瘤模型大白兔分为微导丝电凝治疗组(40只)和空白对照组(10只),采用SilverSpeed微导丝电凝模拟治疗(分别在6 V、9 V、12 V、15 V、18 V电压下通电1 min、3 min、6 min、9 min、12 min、15 min)后观察瘤腔封闭数量和所形成血栓的质量。DSA观察是否有动脉瘤破裂以及是否有载瘤动脉血栓形成。12 h后行头部MRI的弥散加权成像序列扫描,检测载瘤动脉远端的脑供血区是否有新发性脑组织缺血灶。6个月后再次行DSA,观察动脉瘤是否复发。结果(1)电解产气实验结果显示,SilverSpeed微导丝通电后有气泡产生,电压越高则反应越剧烈。扫描电镜下观察显示,在离体血液中通电后的微导丝表面有明显的血栓附着,电压较高时血栓更为致密。(2)相同通电时间下,电压越高,微导丝电凝治疗组大白兔动脉瘤腔完全闭塞数量越多。同一电压下,通电时间越长,所形成血栓的质量越好。缺血事件仅发生在电压>9 V的微导丝电凝治疗组,通电时间长短和栓塞性事件的发生率无关。电压为15 V时,有2只实验兔在通电3 min时发生动脉瘤破裂而死亡。电压为18 V时,有4只实验兔在通电9 min时心跳骤停死亡,另有2只在通电6 min时发生动脉瘤破裂而死亡。结论动脉内微导丝电凝治疗动脉瘤的不良事件主要由高电压引起。设置合适电压后,延长通电时间可提升电凝效果且不会增加安全风险。
Objective To explore the efficacy and safety of intraarterial microguidewire electrocoagulation in arterial aneurysms.Methods(1)SilverSpeed,a kind of microguidewire used in clinical intravascular treatment for intracranial aneurysms,was used to conduct in vitro electrolysis gas generation experiment with isolated arterial blood of anticoagulant New Zealand white rabbits as medium,and thrombus attachment on the surface of microguidewire was observed under scanning electron microscope.(2)Rabbit common carotid artery aneurysm models were established by using vein bag transplantation method,and divided into microguidewire electrocoagulation treatment groups(n=40)and blank control group(n=10).The number of closured tumor cavity and the quality of formed thrombus were observed after electrocoagulation simulation treatment with SilverSpeed microguidewire(charging at 6,9,12,15,and 18 V voltage,respectively for 1,3,6,9,12,and 15 min).DSA was used to observe whether there was ruptured aneurysms or thrombosis of parent artery.Twelve h later,head MRI diffusion weighted sequence scan was performed to detect whether there were new cerebral ischemia foci in the distal cerebral blood supply area of the parent artery.DSA was performed again 6 months after surgery to observe whether the aneurysms recurred.Results(1)Electrolytic gas generation experiment results showed that bubbles were generated after electrification of SilverSpeed microguidewire;the higher the voltage,the more severe the reaction.Scanning electron microscope showed that thrombus attached to the surface of the microguidewire after electrification in isolated blood;and the higher the voltage,the denser the thrombus.(2)Under the same charging time,the higher the voltage,the larger the number of closured tumor cavity in rabbits of the microguidewire electrocoagulation treatment groups.Under the same voltage,the longer the charging time,the better the quality of thrombosis.Ischemic events occurred only in the microguidewire electrocoagulation treatment group with voltage>9 V,and the charging duration was not associated with the incidence of embolic events.When the voltage was 15 V,2 experimental rabbits died due to aneurysm rupture 3 min after electrification.When the voltage was 18 V,4 experimental rabbits died of cardiac arrest 9 min after electrification,and another 2 rabbits died of aneurysm rupture 6 min after electrification.Conclusions High voltage is the main cause of adverse events in the microguidewire electrocoagulation treatment of aneurysms.After setting the appropriate voltage,prolonging the electrification time can improve the electrocoagulation effect without increasing the safety risk.
作者
吴涛
徐龙江
夏维
金志高
吴垚
李照亮
杨德红
陈爱林
戴纯刚
朱卿
Wu Tao;Xu Longjiang;Xia Wei;Jin Zhigao;Wu Yao;Li Zhaoliang;Yang Dehong;Chen Ailin;Dai Chungang;Zhu Qing(Department of Neurosurgery,Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Pathology,Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Imaging,Second Affiliated Hospital of Soochow University,Suzhou 215004,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2022年第5期443-449,共7页
Chinese Journal of Neuromedicine
基金
江苏省研究生科研与实践创新计划(SJCX20_1071)
苏州市科技计划项目(SYS2019067、SYS2019067)
苏州高新区医疗卫生科技计划项目(2018Z014)。
关键词
颅内动脉瘤
电凝
微导丝
血栓形成
安全性
Intracranial aneurysm
Electrocoagulation
Microguidewire
Thrombosis
Safety
作者简介
通信作者:朱卿,Email:suzhouneurousurgeon@126.com。
