醋酸纤维素聚合物栓塞AVM的动物实验研究

目的 探讨非粘附性液体栓塞材料醋酸纤维素聚合物（CAP）栓塞AVM的可行性;寻找CAP和二甲基亚砜（DMSO）栓塞AVM的体内最佳配比;建立通过微导管注射CAP和DMSO的技术程度;评价CAP栓塞AVM的急性和慢性病理改变。方法 采用家猪为实验动物,共26只。通过微导管超选择入猪的颅底血管网（RMB）注射CAP和DMSO。术后一定时期复查脑血管造影。并取标本行光镜和电镜检查。结果 通过微导管注射CAP和DMSO无困难,未发生微导管粘附于血管壁的情况,CAP在RMB内的弥散和铸型良好。亚急性期和慢性造影复查未见血管再通。病理检查主要以内弹力层的出现断裂或消失,单核细胞侵润和散在异物巨细胞反应为主。结论 CAP作为非粘附性液体栓塞材料,无微导管粘附之虞,可以在畸形团内较好弥散和铸型,并达到永久栓塞的目的。其病理反应不引起不良症状,临床上可以接受。

A nonadhensive liquid Embolic material-cellulose acetate polymer(CAP) for embolization of cerebral arteriovenous malformation: an experimental study

Objective To study the feasibility and safety of embolization of AVM with CAP in swine models, and determine the optimum in vivo proportion of CAP to DMSO for embolization of AVMs. To observe the histopathological changes induced by CAP and To develop techniques for endovascular delivery of CAP through microcatheters into swine rete mirabile(RMB). Methods 26 swine were used for the CAP embolization in this study. Angiographic and histopathological evaluations were made at 3 days,14 days,1 month,3 month and 6 months after the embolization procedure.Results There was no difficulty in delivering CAP/DMSO mixture through the microcatheter and no occurrence of catheter"gluing". The mixture could well diffuse into the RMB and form a cast. There was no angiographic recanalization at follow up. Main pathological changes were the disruption or disappearance of internal lammina elstica and scattered inflammation response manifested by the foreign body giant cell reaction. Conclusions CAP/DMSO mixture can achieve permanent occlusion of swine RMB with pathological changes clinically acceptable, and without untoward catheter"gluing" and clinical complications. Judged from the angiographic and pathological results in this series, it seems to be an excellent liquid nonadhensive embolic material in treatment of cerebral arteriovenous malformations.