Lanzino G, Miskolczi L, Guterman L R, Hopkins L N
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 14209-1194, USA.
Neurosurgery. 1999 Sep;45(3):609-13. doi: 10.1097/00006123-199909000-00032.
To test the concept that endovascular angioscopy can assist surgical intracranial aneurysm clipping by providing an endoluminal view of the aneurysm-parent vessel complex.
A carotid bifurcation aneurysm was surgically created in a dog at the lingual artery origin. A balloon catheter was inflated proximal to the aneurysm to block proximal blood flow and allow endoluminal visualization. A flexible angioscope connected to a video monitoring system and to a high-intensity light source was then advanced within the catheter lumen and positioned immediately distal to the catheter tip. The aneurysm neck was clipped, and the clip was repositioned several times along the neck, with or without distal parent vessel compromise. Each time, the endovascular image on the monitor was interpreted by an observer blinded to the position of the clip. Clip position and image interpretation were communicated independently to a third person, who analyzed the correlation between them.
Angioscopy allowed clear visualization of the extent of aneurysm neck occlusion (complete, incomplete, residual "dog ear") after clip application, as well as the presence or absence of distal parent vessel compromise. Aneurysm neck configuration, size, presence of thrombus, and suture line definition were depicted. Critical structures external to the aneurysm-parent vessel complex were transilluminated by the high-intensity lamp.
Although acknowledged as the treatment of choice for intracranial aneurysms, surgical exclusion can be accompanied by significant morbidity related to perforator occlusion, parent artery compromise, and/or persistent residual aneurysm. The availability of a device allowing visualization of an aneurysm from an endoluminal perspective theoretically could reduce the incidence of these complications. Angioscopy has the potential to become a useful adjunct during intracranial aneurysm clipping because it provides real-time endoluminal viewing of the aneurysm-distal parent vessel complex, which is sometimes obscured to the surgeon.
通过提供动脉瘤-载瘤血管复合体的腔内视图，测试血管内血管镜检查辅助颅内动脉瘤手术夹闭的概念。
在一只犬的舌动脉起始处手术制造一个颈内动脉分叉处动脉瘤。在动脉瘤近端充盈球囊导管以阻断近端血流并实现腔内可视化。然后将连接到视频监测系统和高强度光源的柔性血管镜推进到导管腔内，并定位在导管尖端的紧邻远端。夹闭动脉瘤颈部，并沿颈部多次重新定位夹子，无论远端载瘤血管是否受损。每次，由对夹子位置不知情的观察者解读监视器上的血管内图像。夹子位置和图像解读分别传达给第三人，由其分析两者之间的相关性。
血管镜检查能够清晰显示夹闭后动脉瘤颈部闭塞的程度（完全、不完全、残留“狗耳”），以及远端载瘤血管是否受损。描绘了动脉瘤颈部的形态、大小、血栓存在情况和缝线边界。高强度灯可透照动脉瘤-载瘤血管复合体外部的关键结构。
尽管手术夹闭被公认为颅内动脉瘤的首选治疗方法，但可能会伴随与穿支闭塞、载瘤动脉受损和/或持续性残留动脉瘤相关的显著发病率。理论上，一种能够从腔内视角观察动脉瘤的设备的可用性可以降低这些并发症的发生率。血管镜检查有可能成为颅内动脉瘤夹闭过程中的一种有用辅助手段，因为它能提供动脉瘤-远端载瘤血管复合体的实时腔内视图，而这有时对外科医生来说是模糊不清的。
