带膜支架在神经介入治疗中的应用现状

学术背景: 随着神经介入医学的不断发展,带膜支架在神经介入中的优越性越来越被认可,其应用也越来越受到重视.目的:介绍带膜支架的材料类型,总结带膜支架在神经介入中的应用现状及不足之处.检索策略:由该论文的研究人员应用计算机检索Pubmed数据库的相关文献资料,以"stent graft, covered stents, cerebrovascular disease"为检索词,共检索到223篇相关文献,应用维普数据库以"带膜支架,脑血管疾病"作为检索词,共找到196篇中文文献.对资料进行初审,纳入标准:①与带膜支架在神经介入中的应用密切相关,特别是脑血管介入密切相关.②近期发表或是权威杂志上发表的文章.排除标准:重复性研究.文献评价:计算机初检得到223篇英文相关文献,中文文献196篇,阅读标题及摘要进行初筛,排除重复性研究,共纳入31篇文献,综述4篇,基础研究3篇,其余为临床研究.资料综合:因带膜支架在神经介入治疗中所体现出的独特优越性,该支架正在成为研究的热点.带膜支架在出血性脑血管疾病中的应用,目前均为个案或小宗病例报道.已有报道说明应用带膜支架可有效的闭塞动脉瘤、夹层动脉瘤、动静脉瘘等病变,且能保持载瘤动脉通畅.带膜支架以膜性物理屏障隔离溃疡斑块,避免了栓子脱落,有可能进一步减少经皮颈内动脉支架置入术过程中的栓塞事件的发生.并且带膜支架释放后,聚四氟乙烯膜使管壁更加光滑,其良好的生物相容性,使血栓形成减少,进而使管腔再狭窄的发生率减低.尽管血管内带膜支架用于脑血管病的治疗已取得了显著的效果,但应用中也存在一些问题:①带膜支架最主要的缺陷是闭塞它所覆盖范围的分支小血管.②覆膜支架置入术后的血栓形成及再狭窄问题.③覆膜材料增加了支架的体积,减少了支架的顺应性和柔韧性,加大了推送的难度及对血管损伤的可能性.④血管直径小于4 mm,不适宜使用带膜支架.结论:带膜支架在颅内缺血性和出血性疾病的应用中正日益显示出其显著的疗效,但也有其不足之处.随着相关理论研究的深入及新材料工艺的进步,带膜支架在脑血管疾病治疗中的应用将会更加广泛.

Covered stents in neural interventional therapy

BACKGROUND: With the development of neural interventional therapy, the application of covered stents in neural intervention is becoming a topic of general interest.OBJECTIVE: To introduce the structure of stent-graft, and to summary the application of covered stents in clinical treatment of the neural interventional therapy and the shortage of covered stents.RETRIEVAL STRATEGY: The relevant articled were searched for in Pubmed database by researcher of this article with the key words of "stent graft, covered stents, cerebrovascular disease" in English, and with the key words of "covered stent, cerebrovascular disease" in Chinese in VIP database. 223 English and 196 Chinese articles were selected and reviewed primarily. Inclusive criteria: Articles having a close relation with the application of covered stents in neural intervention, especially in cerebrovascular disease, and the latest articles or articles published in authority journals in the same field were chosen. Exclusive criteria: articles with repetitive studies were excluded.LITERATURE EVALUATION: 223 English and 196 Chinese articles were primarily checked by reading titles and abstracts. Among the 31 collected articles, 4 are reviews, 3 are experimental studies and others are clinical studies.DATA SYNTHESIS: Covered stents show special advantages in neural interventional therapy and become a hot spot in present study. There are individual case reports or small group case reports on the application of covered stents in hemorrhagic cerebrovascular disease. It is reported that the covered stent effectively occludes aneurysm, dissecting aneurysm and arteriovenous fistula, keeps patency of the parent artery. The covered stent isolates ulcerated plaque via physical barriers, avoids the abscission of embolus, which can further reduce the development of embolism in percutaneous carotid artery stenting. After releasing covered stents, polytetrafluoroethylene makes the disepiment smooth. Its good biocompatibility reduces thrombosis, and then decreases the incidence of restenosis. Covered stents in vessel for cerebrovascular disease have achieved good effects, but there are some problems in clinic as follows. ①The main shortage of covered stents is to occlude small branch vessels. ②Thrombosis and restenosis occur after covered stenting. ③Covered stents increase the volume of the stent, reduce the compliance and flexibility of the stents, and increase the pushing difficulty and vascular injury. ④Covered stents cannot be used in vessels of less than 4 mm.CONCLUSION: Covered stents for intracranial ischemic and hemorrhagic diseases shows significant outcomes, but there are disadvantages. With the clarification of the related theories and the improvement of new material technology, there will be a brighter future of the application of covered stents for treatment of cerebrovascular diseases.