Nishi Shogo, Nakayama Yasuhide, Ishibashi-Ueda Hatsue, Matsuda Takehisa
Department of Neurosurgery, Takatsuki Red Cross Hospital, Osaka, Japan.
Neurosurgery. 2003 Dec;53(6):1397-404; discussion 1404-5. doi: 10.1227/01.neu.0000093427.89827.12.
An embolization technique using a stent graft has been developed to replace the conventional type of direct surgery or neurointervention with platinum coils and/or bare stents. The utility of a commercially available metal stent wrapped with a microporous elastomeric film coated with a thin, heparin-loaded, photocured gelatinous layer for the treatment of experimental carotid artery sidewall aneurysms in dogs was evaluated.
The stent graft was used for embolization of experimental carotid artery aneurysms in dogs. The aneurysms were prepared bilaterally in canine carotid arteries with branching of an external jugular vein patch.
The entries into all of the aneurysms were occluded immediately after placement of the stent grafts, and the aneurysms were embolized by thrombus formation even 1 week after deployment. All of the parent carotid arteries in which stent grafts were placed were patent, without severe stenosis, immediately (n = 2), 1 week (n = 4), 1 month (n = 3), and 3 months (n = 4) after placement. Scanning electron microscopy demonstrated that the luminal surfaces of the stent grafts were entirely endothelialized as soon as 1 week after placement, via transmural tissue ingrowth through the micropores formed in the covering film.
The stent graft we have developed seems to be highly promising for the treatment of aneurysms, especially with respect to immediate termination of blood inflow for aneurysm occlusion and rapid endothelialization in the aneurysm neck.
已开发出一种使用覆膜支架的栓塞技术，以取代传统的直接手术或用铂金线圈和/或裸支架进行的神经介入治疗。评估了一种市售的金属支架，其包裹有涂覆薄的、负载肝素的光固化凝胶层的微孔弹性体膜，用于治疗犬实验性颈动脉侧壁动脉瘤的效用。
将覆膜支架用于犬实验性颈动脉动脉瘤的栓塞。在犬颈动脉双侧制备带有颈外静脉补片分支的动脉瘤。
放置覆膜支架后，所有动脉瘤的入口立即被闭塞，即使在放置后1周，动脉瘤也因血栓形成而被栓塞。放置覆膜支架的所有颈总动脉在放置后即刻（n = 2）、1周（n = 4）、1个月（n = 3）和3个月（n = 4）均保持通畅，无严重狭窄。扫描电子显微镜显示，放置后1周，覆膜支架的管腔表面通过覆盖膜中形成的微孔的透壁组织向内生长而完全内皮化。
我们开发的覆膜支架似乎在动脉瘤治疗方面极具前景，尤其是在立即终止血液流入以闭塞动脉瘤以及在动脉瘤颈部快速内皮化方面。
