钨弹簧圈栓塞动脉瘤模型后早期病理改变的实验研究

目的探讨钨弹簧圈栓塞动脉瘤模型后的病理演变规律,特别是钨弹簧圈的溶解及其与动脉瘤复发的关系。方法以机械可脱性钨弹簧圈栓塞经弹力酶处理的兔侧方、顶端和分叉部动脉瘤模型,利用电偶合等离子体质谱测定明确血清内是否含有金属钨,分析从栓塞前到栓塞后5个月内血钨的变化规律,栓塞后5个月时取标本行HE染色、Ⅷ因子免疫组化、扫描电镜、透射电镜等病理检查。电偶合等离子体质谱测定弹簧圈周围组织是否含有金属钨。结果成功建立和栓塞动脉瘤模型7枚,5枚完全栓塞,2枚部分栓塞。栓塞后平片检查,没有发现弹簧圈密度的明显变化。血钨在栓塞后1个月开始升高,最高峰在术后2个月,栓塞后4、5个月血钨水平开始下降,都与栓塞前有显著性差异(P<0.05)。电感耦合等离子体质谱分析结果(ICP-MS)显示钨弹簧圈周围组织中含有金属钨。钨弹簧圈栓塞动脉瘤模型后可以诱发血栓形成、机化,动脉瘤颈部被内皮覆盖,可见弹簧圈层状脱落,变细,部分裸露的弹簧圈变细更加明显。结论以钨弹簧圈栓塞动脉瘤模型后,动脉瘤内的弹簧圈存在溶解破坏的现象,但并不伴随动脉瘤的复发。钨弹簧圈可以用于栓塞动脉瘤。

Experimental research of pathological changes in early stage after embolization of aneurysmal models with tungsten coils

Objectives To explore the characteristics of the pathological changes after embolization of the aneurysmal models with tungsten coils. Especially to find out if there is relation between the corrosion of coils and recurrence of the occluded aneurysms. Methods Elastase induced lateral, terminal, and bifurcation aneurysmal models of rabbits were embolized with tungsten mechanical detachable coils. Inductively coupled plasma mass spectrometry(ICP-MS)was used to test if tungsten element could be found in rabbit serum. Tendency of change of serum tungsten between pre-embolization and post-embolization in 5 months was analyzed. Samples were resected 5 months after embolization. HE stain, VIII factor immunochemical stain, scanning and transmission electron microscope, were utilized for pathological research. ICP-MS was used to search if there was tungsten element in the tissue around coils. Results Seven aneurysmal models were successfully built and embolized. Five were completely occluded, 2 were partially occluded. No obvious changes of the density of the tungsten coils could be found in the plain film in various stages. The level of tungsten in the serum increased one month after embolization, reached peak two months after embolization, and began to decrease four to five months after embolization. Serum tungsten level of post -occlusion at various stages was significantly different from pre-occlusion level(P<0.05). ICP-MS could verify that there was indeed tungsten element in the tissue around coils. Tungsten coils could lead to the formation and organization of thrombus, and endothelial coverage over the neck of the aneurysms. The surface of the coils is covered by layers of crust that bursts in the form of the sandwich, and became slimmer. It is more prominent at exposed part of the coils. Conclusions The tungsten coils could be corroded after the embolization of aneurysmal models. This did not induce the recurrence of the occluded aneurysms. Tungsten coils can be used as embolic material for aneurysms.