高浓度乙烯-乙烯醇共聚物与实验性动脉瘤的血管内治疗：在瘤颈无保护装置情况下进行栓塞的可行性

High-concentration ethylene-vinyl alcohol copolymer and endovascular treatment of experimental aneurysms: feasibility of embolization without protection devices at the neck.

作者信息

Raymond Jean, Salazkin Igor, Metcalfe Annick, Guilbert François, Weill Alain, Roy Daniel

机构信息

Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada.

出版信息

AJNR Am J Neuroradiol. 2003 Oct;24(9):1778-84.

PMID:14561602

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7976295/

Abstract

BACKGROUND AND PURPOSE

Coiling of intracranial aneurysms is both safe and effective but may be followed by recurrences. The purpose of this study was to assess the feasibility of endovascular treatment of aneurysms with high-concentration ethylene-vinyl alcohol copolymer (HCEVOH), without the use of protection devices at the neck.

METHODS

Wide-necked bifurcation aneurysms with a high propensity for recurrences were constructed in 22 dogs. HCEVOH embolization was performed with a dedicated high-pressure microcatheter in 12 animals. Angiographic results at 3 and 12 weeks and pathologic results at 12 weeks were compared with those of a separate group of 10 animals treated with platinum coils. We used a qualitative scoring system to grade angiographic results, neointima formation, and recanalization at the neck.

RESULTS

Intraaneurysmal HCEVOH injections could be performed without carotid emboli and without a protection device in 11 of 12 animals. Fragments detached upon traction of the microcatheters at the end of the procedure on two occasions. Immediate and late angiographic results were not significantly different between the two groups (P =.807), with a tendency for angiographic recurrences at 3 months (angiographic scores were significantly worse in both groups at 12 weeks as compared with T0 [P <.02]). A complete occlusion, including the neck, even at the cost of protrusion of material at the level of the branches, is necessary to decrease risks of recurrences. Neointima formation at the surface of the embolic agent was complete at the neck of aneurysms treated with HCEVOH. The neointimal score was significantly improved with HCEVOH as compared with coil embolization (P =.03).

CONCLUSION

HCEVOH embolization of aneurysms without neck protection is feasible. It does not, however, eliminate recurrences in an experimental wide-necked aneurysm model.

摘要

背景与目的

颅内动脉瘤的血管内栓塞术既安全又有效，但术后可能会复发。本研究的目的是评估在不使用颈部保护装置的情况下，用高浓度乙烯-乙烯醇共聚物（HCEVOH）进行动脉瘤血管内治疗的可行性。

方法

在22只犬中构建具有高复发倾向的宽颈分叉动脉瘤。12只动物用专用高压微导管进行HCEVOH栓塞。将3周和12周时的血管造影结果以及12周时的病理结果与另一组10只用铂线圈治疗的动物的结果进行比较。我们使用定性评分系统对血管造影结果、新生内膜形成和颈部再通进行分级。

结果

12只动物中有11只在不使用颈动脉栓子和保护装置的情况下进行了瘤内HCEVOH注射。在操作结束时，有两次微导管牵引时碎片脱落。两组的即时和晚期血管造影结果无显著差异（P = 0.807），3个月时有血管造影复发的趋势（与T0相比，两组在12周时的血管造影评分均显著更差[P < 0.02]）。为降低复发风险，包括颈部在内的完全闭塞是必要的，即使以分支水平处材料突出为代价。在用HCEVOH治疗的动脉瘤颈部，栓塞剂表面的新生内膜形成是完整的。与线圈栓塞相比，HCEVOH治疗的新生内膜评分显著改善（P = 0.03）。