Murayama Y, Viñuela F, Tateshima S, Song J K, Gonzalez N R, Wallace M P
Division of Interventional Neuroradiology, Leo G. Rigler Radiological Research Center, University of California at Los Angeles School of Medicine, 90024, USA.
J Neurosurg. 2001 Mar;94(3):454-63. doi: 10.3171/jns.2001.94.3.0454.
A new embolic agent, bioabsorbable polymeric material (BPM), was incorporated into Guglielmi detachable coils (GDCs) to improve long-term anatomical results in the endovascular treatment of intracranial aneurysms. The authors investigated whether BPM-mounted GDCs (BPM/GDCs) accelerated the histopathological transformation of unorganized blood clot into fibrous connective tissue in experimental aneurysms created in swine.
Twenty-four experimental aneurysms were created in 12 swine. In each animal, one aneurysm was embolized using BPM/GDCs and the other aneurysm was embolized using standard GDCs. Comparative angiographic and histopathological data were analyzed at 2 weeks and 3 months postembolization. At 14 days postembolization, angiograms revealed evidence of neck neointima in six of eight aneurysms treated with BPM/GDCs compared with zero of eight aneurysms treated with standard GDCs (p < 0.05). At 3 months postembolization, angiograms demonstrated that four of four aneurysms treated with BPM/GDC were smaller and had neck neointima compared with zero of four aneurysms treated with standard GDCs (p = 0.05). At 14 days, histological analysis of aneurysm healing favored BPM/GDC treatment (all p < 0.05): the grade of cellular reaction around the coils was 3 +/- 0.9 (mean +/- standard deviation) for aneurysms treated using BPM/GDCs compared with 1.6 +/- 0.7 for aneurysms treated using GDCs alone; the percentage of unorganized thrombus was 16 +/- 12% compared with 37 +/- 15%, and the neck neointima thickness was 0.65 +/- 0.26 mm compared with 0.24 +/- 0.21 mm, respectively. At 3 months postembolization, only neck neointima thickness was significantly different (p < 0.05): 0.73 +/- 0.37 mm in aneurysms filled with BPM/GDCs compared with 0.16 +/- 0.14 mm in aneurysms filled with standard GDCs.
In experimental aneurysms in swine, BPM/GDCs accelerated aneurysm fibrosis and intensified neck neointima formation without causing parent artery stenosis or thrombosis. The use of BPM/GDCs may improve long-term anatomical outcomes by decreasing aneurysm recanalization due to stronger in situ anchoring of coils by organized fibrous tissue. The retraction of this scar tissue may also decrease the size of aneurysms and clinical manifestations of mass effect observed in large or giant aneurysms.
一种新型栓塞剂，即生物可吸收聚合物材料（BPM），被应用于 Guglielmi 可脱卸弹簧圈（GDC），以改善颅内动脉瘤血管内治疗的长期解剖学效果。作者研究了装载 BPM 的 GDC（BPM/GDC）是否能加速猪实验性动脉瘤内无组织血凝块向纤维结缔组织的组织病理学转变。
在 12 头猪身上制造了 24 个实验性动脉瘤。在每只动物中，一个动脉瘤用 BPM/GDC 栓塞，另一个动脉瘤用标准 GDC 栓塞。在栓塞后 2 周和 3 个月分析比较血管造影和组织病理学数据。栓塞后 14 天，血管造影显示，用 BPM/GDC 治疗的 8 个动脉瘤中有 6 个出现颈部新内膜的迹象，而用标准 GDC 治疗的 8 个动脉瘤中无一出现（p < 0.05）。栓塞后 3 个月，血管造影显示，用 BPM/GDC 治疗的 4 个动脉瘤中有 4 个更小且有颈部新内膜，而用标准 GDC 治疗的 4 个动脉瘤中无一如此（p = 0.05）。在 14 天时，动脉瘤愈合的组织学分析支持 BPM/GDC 治疗（所有 p < 0.05）：使用 BPM/GDC 治疗的动脉瘤，弹簧圈周围的细胞反应等级为 3 ± 0.9（平均值 ± 标准差），而单独使用 GDC 治疗的动脉瘤为 1.6 ± 0.7；无组织血栓的百分比分别为 16 ± 12% 和 37 ± 15%，颈部新内膜厚度分别为 0.65 ± 0.26 mm 和 0.24 ± 0.21 mm。栓塞后 3 个月，只有颈部新内膜厚度有显著差异（p < 0.05）：填充 BPM/GDC 的动脉瘤为 0.73 ± 0.37 mm，而填充标准 GDC 的动脉瘤为 0.16 ± 0.14 mm。
在猪的实验性动脉瘤中，BPM/GDC 加速了动脉瘤纤维化并增强了颈部新内膜形成，且未导致载瘤动脉狭窄或血栓形成。使用 BPM/GDC 可能通过减少因有组织纤维组织对弹簧圈更强的原位锚定作用而导致的动脉瘤再通，从而改善长期解剖学结果。这种瘢痕组织的收缩也可能减小动脉瘤的大小以及大型或巨大动脉瘤中观察到的占位效应临床表现。
