犬肝内动脉覆膜支架置入的实验研究

目的从支架置入的成功率、贴壁性、支架内狭窄率及支架内皮化等诸方面探讨犬肝内动脉覆膜支架置入的可行性。方法成年毕格犬8只,全麻下采用介入技术在其肝右动脉/肝固有动脉内置入球囊扩张式可膨胀聚四氟乙烯(ePTFE)覆膜膜支架,置入后即刻及术后2、4和12周行DSA复查,观察支架置入过程及其造影表现、标本的组织病理学表现,对参数进行统计学分析。结果支架均输送到位并顺利置入8只犬肝右动脉/肝固有动脉;支架释放后贴壁性能良好,所隔绝的动脉分支未显影;以管腔丢失>50%为明显狭窄标准,2周复查时有2只犬出现支架内明显狭窄,12周复查时有3只犬出现支架内明显狭窄(3/8)。病理显示2只犬为血栓形成、1只犬为内膜增生所致;5只犬支架出现完全内皮化(标本3个不同取材部位均完全内皮化),3只犬支架内皮化不完全(标本3个取材部位至少有1处未内皮化);支架两端较中央部更易形成内皮化;支架置入前后,所有犬肝功能均未出现显著改变。结论球囊扩张式覆膜膜支架能够顺利置入犬肝动脉,并且具有良好的贴壁性,能形成完整的内皮化,不会对肝功能带来影响。覆膜支架的犬肝内动脉置入是可行的。

Experimental research of covered stent implanted in canine hepatic artery

Objective To evaluate the feasibility of success rate of implantation,post-procedure stenosis rate,apposition ability and endothelialization level,etc.for implantation with balloon-expandable covered stent in canine hepatic artery.Methods 8 adult canines were implanted with balloon-expendable stents covered by expandable poly Teflon ester membrane(e-PTFEM) .Follow-up DSA was performed immediately,2,4 and 12 wk after the procedure.The canines were sacrificed for histopathologic examination and statistical analysis with correlation of implantation manenvor and angiographic manifestations.Results 8 cases were all implanted with the covered stents in proper hepatic artery/right hepatic artery successfully;showing good apposition ability and non-opacification of the separated branches.2 cases showed intraluminal obvious stenosis(> 50%) of the stent at 2 weeks follow-up,so did 3 cases at 12 weeks follow-up,and the total stenosis rate was 37.5% and 5 cases manifested full endothelialization(3 different locations of the sample all manifested full endothelialization) ,3 cased manifested partial endothelialization(at least 1 location of the sample didn't show full endothelialization) ,and the two terminal parts were easier to get endothelialization than the central part.Before and after the stent implantation,hepatic function of all cases didn't demonstrate any obvious changes.Conclusions Balloon-expandable covered stent can be implanted in canine hepatic artery successfully,with good apposition ability,full endothelialization,and no influence on hepatic function.