Krings Timo, Hans Franz J, Möller-Hartmann Walter, Brunn Anna, Thiex Ruth, Schmitz-Rode Thomas, Verken Peter, Scherer Kira, Dreeskamp Heiko, Stein Klaus P, Gilsbach Joachim, Thron Armin
Department of Neuroradiology, University Hospital, University of Technology, Aachen, Germany.
Neurosurgery. 2005 Jun;56(6):1347-59; discussion 1360. doi: 10.1227/01.neu.0000159887.03290.d1.
Although Guglielmi detachable coil systems have been widely accepted for treatment of intracranial aneurysms, primary stenting of aneurysms using porous stents, stent grafts, or implantation of coils after stent placement constitute emerging techniques in endovascular treatment. The aim of the present study was to use an animal model to investigate these different approaches to treat cerebral aneurysms with regard to the rate of closure and the histopathological changes within the aneurysm cavity and the parent vessel after stent placement.
We created aneurysms in 30 rabbits by distal ligation and intraluminal incubation of the right common carotid artery with elastase. Ten animals were treated with porous stents alone, 10 animals with stent grafts (covered stents), and 10 animals with stents and additional coiling via the interstices of the stent, which enabled dense packing of the coils. Five animals in each group were observed for 1 month and the other animals for 3 months. Histological analyses were performed, including immunohistochemical investigations for estimating the proliferation of the intima and possible inflammatory infiltration.
Covered stents led to a complete and stable aneurysm occlusion with only minimal proliferative carrier vessel wall changes. One covered stent was completely occluded with old thrombus, and the other 9 remained patent. Porous stents occluded two of five aneurysms in the 1-month follow-up group and four of five after 3 months. However, progressive sprouting of neointima inside the carrier vessel that resulted in a stenosis of up to 40% was present. In the Stent + Coil group, one aneurysm showed recanalization after 1 month, and three of five aneurysms were recanalized after 3 months after coil compaction. Moreover, in-stent stenosis of up to 30% was present.
This study demonstrates the possible shortcomings and problems of emerging stent techniques to treat intracerebral aneurysms, shows where technical advances have to be made, and describes in which cases of aneurysm morphology caution has to be exercised when considering an endovascular approach using stents.
尽管 Guglielmi 可脱卸弹簧圈系统已被广泛用于治疗颅内动脉瘤，但使用多孔支架、覆膜支架对动脉瘤进行初次支架置入或在支架置入后植入弹簧圈是血管内治疗中新兴的技术。本研究的目的是使用动物模型，研究这些不同的治疗脑动脉瘤的方法在支架置入后动脉瘤腔和载瘤血管内的闭合率以及组织病理学变化。
我们通过对 30 只兔子的右颈总动脉进行远端结扎并腔内注入弹性蛋白酶来制造动脉瘤。10 只动物仅接受多孔支架治疗，10 只动物接受覆膜支架（带膜支架）治疗，10 只动物接受支架及通过支架间隙额外植入弹簧圈治疗，这使得弹簧圈能够紧密填充。每组 5 只动物观察 1 个月，其他动物观察 3 个月。进行了组织学分析，包括免疫组织化学研究以评估内膜增殖和可能的炎症浸润。
覆膜支架导致动脉瘤完全且稳定地闭塞，载瘤血管壁仅出现最小程度的增殖性变化。1 个覆膜支架被陈旧血栓完全闭塞，另外 9 个保持通畅。在 1 个月随访组中，多孔支架使 5 个动脉瘤中的 2 个闭塞，3 个月后使 5 个中的 4 个闭塞。然而，载瘤血管内新生内膜逐渐增生，导致高达 40%的狭窄。在支架 + 弹簧圈组中，1 个动脉瘤在 1 个月后出现再通，3 个月后 5 个动脉瘤中有 3 个在弹簧圈压实后再通。此外，出现了高达 30%的支架内狭窄。
本研究证明了新兴支架技术治疗脑动脉瘤可能存在的缺点和问题，指出了必须在哪些方面取得技术进步，并描述了在考虑使用支架的血管内治疗方法时，对于哪些动脉瘤形态需要谨慎操作。
