摘要
目的建立Wallstent双支架重叠置入治疗小型猪颈总动脉动脉瘤模型,通过观察其影像学和病理学愈后改变评估该术式的安全性和有效性。方法采用外科方式建立巴马小型猪侧壁和梭形动脉瘤模型并原位重叠置入2枚Wallstent支架。参照OKM分级和Kamran评分标准评估术后即刻和随访8周期间动脉瘤闭塞情况。通过高分辨C臂CT(HR-CBCT)和光学相干断层扫描(OCT)观察术后即刻支架贴壁程度和术后2周、4周、8周末支架内皮化及动脉瘤愈合情况并结合8周末组织病理学结果评估支架内皮化进程。观察并记录围手术期间不良事件发生情况。结果8头小型猪颈总动脉动脉瘤模型均构建成功,包括4枚侧壁动脉瘤和4枚梭形动脉瘤,内径(11.0±2.8)mm。原位共重叠置入16枚Wallstent支架(各重叠置入2枚),技术成功率100%。围手术期未观察到支架内急性血栓形成及动脉瘤破裂出血等严重并发症发生。术后即刻2D-DSA显示动脉瘤内对比剂明显滞留6例(1级1例,2级3例和3级2例)、动脉瘤闭塞2例(分级均为4级),至8周末随访时8枚动脉瘤均完全闭塞(分级均为4级);同时2头实验猪出现支架内再狭窄,狭窄率分别为52%和67%。术后即刻和随访期间HR-CBCT和OCT提示支架金属编织丝逐步被增生的血管内膜所覆盖,动脉瘤消失;2例支架内再狭窄原因为支架贴壁不良导致的局部内膜过度增生,病理结果提示增生的血管内膜主要由平滑肌细胞和纤维结缔组织构成。结论Wallstent支架重叠置入治疗动物模型体内的颈总动脉瘤安全、有效,但术中应避免重叠支架贴壁不良情况发生。
Objective To establish the common carotid artery aneurysm models of Wallstent double stent overlapping implantation in miniature pigs,and evaluate the safety and effectiveness of this procedure by observing the imaging and pathological changes.Methods Sidewall aneurysm and fusiform aneurysm models in Bama miniature pigs were established surgically and 2 Wallstent stents were overlapped and implanted in situ.Aneurysm healing immediately after surgery and during 8 weeks of follow-up were evaluated according to 2D-DSA by O'Kelly-Marotta(OKM)grading scale and Kamran scale;degrees of stent adhesion immediately after surgery and status of stent endothelialization and aneurysm healing at 2,4,and 8 weeks after surgery were observed by high resolution C-arm CT(HR-CBCT)and optical coherence tomography(OCT);and the changes of stent endothelialization were evaluated by comparing the HR-CBCT and OCT results with histopathology at 8 weeks after surgery.Perioperative adverse events were recorded.Results After successful establishment of common carotid artery aneurysm models(including 4 sidewall aneurysms and 4 fusiform aneurysms with average diameter of[11.0±2.8]mm)in 8 miniature pigs,a total of 16 Wallstent stents(2 in each aneurysm)were implanted across the aneurysmal neck,with a technical success rate of 100%.No serious complications such as acute stent thrombosis,or aneurysm rupture and bleeding were observed in the perioperative period.The 2D-DSA immediately after surgery showed obvious intracranial contrast agent retention in 6 patients(1 patient in grading 1,3 in grading 2,and 2 in grading 3)and aneurysm occlusion in 2 patients(grading 4).Eight weeks after follow-up,all 8 aneurysms had complete occlusions(grading 4);and 2 experimental pigs had in-stent restenosis,with stenosis rates of 52%and 67%,respectively.HR-CBCT and OCT immediately after surgery and during follow-up indicated that the stent metal braid was gradually covered by proliferating intima,with disappeared aneurysm.The cause of in-stent restenosis in 2 experimental pigs was local intima hyperplasia resulted from poor stent adhesion,and pathological findings indicated that the intima hyperplasia was mainly composed of smooth muscle cells and fibrous connective tissues.Conclusion In animal models,Wallstent stent overlapping implantation is safe and effective in common carotid aneurysms,but intraoperative adverse adhesion of overlapping stent should be avoided.
作者
李腾飞
田奇
史帅龙
龙树海
苗仁英
汤亦
水少锋
闫磊
郭栋
段旭华
李臻
韩新巍
马骥
Li Tengfei;Tian Qi;Shi Shuailong;Long Shuhai;Miao Renying;Tang Yi;Shui Shaofeng;Yan Lei;Guo Dong;Duan Xuhua;Li Zhen;Han Xinwei;Ma Ji(Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Vascular Surgery,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Cardiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华神经医学杂志》
CSCD
北大核心
2023年第11期1091-1097,共7页
Chinese Journal of Neuromedicine
基金
国家自然科学基金(81801806)
河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029)
河南省医学教育研究项目(WJLX2021286)。
作者简介
通信作者:马骥,Email:soulma@126.com。
