血管内支架结合弹簧圈栓塞犬宽颈动脉瘤的病理学研究

目的通过观察支架置入及支架结合弹簧圈栓塞后动脉瘤口处新生内膜覆盖情况,进一步分析评价网孔支架置入及支架结合弹簧圈栓塞治疗宽颈动脉瘤的有效性。方法8只犬建立双侧颈动脉宽颈动脉瘤模型,一侧行支架置入,对侧行支架结合弹簧圈栓塞,分别对术后2d、1个月和1年组织病理学检查(大体观察,光镜检查、扫描电镜和透射电镜检查)。结果单纯支架置入治疗动脉瘤很难形成瘤内血栓,支架网丝可以促进新生内膜生长,但较难完全覆盖动脉瘤口,支架结合弹簧圈栓塞动脉瘤可以较快促进瘤内血栓形成,并能促进新生内膜完全覆盖动脉瘤口。结论支架结合弹簧圈栓塞动脉瘤可以促进动脉瘤的解剖学治愈,但尚需人类组织学研究进一步证实。

Histopathological study of aneurysm after treatment with stent and coil in a canine model

Objective To discuss the mechanism of neointima growth on the wide-necked aneurysm orifice after the treatment with stents and coils or with stents alone, and to assess the effectiveness of this endovascular approach in the treatment of wide-neck aneurysms in a canine model. Methods Experimental aneurysms were surgically constructed on bilateral carotid arteries in eight canines to simulate intracranial wide-necked aneurysms. Balloon-expandable metal porous stents ( BX stent) were successfully positioned across the orifice of wide-necked aneurysms on 16 carotid arteries in eight dogs. Among them, coils were loosely packed into one aneurysm through mesh of the stents in each of the 8 dogs. All aneurysms treated were resected for histopathologic study at different stages. Results Neointima growth can be seen at one month after stent plus coils or stent alone. It is difficult that neointima cover completely the orifice after stent placement alone. Neointima can completely cover the neck of the aneurysm after treated with stent plus coils. Conclusions We consider that stent struts and coils can promote fibroblast proliferation which synthesize and excrete a lot of collagen fibers at (he aneurysm neck, and endothelial cells can grow on the surface of collagen fiber to cover the orifice of the aneurysm.