Szikora I, Seifert P, Hanzely Z, Kulcsar Z, Berentei Z, Marosfoi M, Czirjak S, Vajda J, Nyary I
National Institute of Neurosurgery, Budapest, Hungary.
AJNR Am J Neuroradiol. 2006 Feb;27(2):283-8.
The purpose of this study was to evaluate the degree of organization and fibrocellular tissue development in aneurysms treated with bare platinum or biologically active microcoils.
Twelve aneurysms were removed at autopsy between 1-18 days and another 2 between 2-3 months posttreatment. Four aneurysms were surgically removed between 6 months and 3 years following treatment. One aneurysm removed at 8 days and another at 6 months were treated with bioactive (Matrix) coils; the other 16 with bare platinum (Guglielmi detachable coils; GDCs). All specimens were embedded in plastic, stained with hematoxilin-eosin and elastin and examined by light microscopy.
All specimens removed within 3 weeks demonstrated intra-aneurysmal thrombus, without signs of organization or fibrotic tissue formation over the neck regardless of the type of coils used. In the GDC-treated aneurysms, evidence of early thrombus organization was observed within 2-3 months, and completed yet imperfect fibrocellular reaction together with residual thrombus at 2-3 years. In the Matrix-treated specimens, the aneurysm cavity was completely filled with granulation tissue corresponding to still ongoing fibrocellular reaction at 6 months, including newly formed blood vessels, smooth muscle cells, and collagen deposition without signs of residual thrombus.
Our results indicate that in aneurysms treated with bare platinum coils thrombus organization does not occur until late after treatment and may remain imperfect for years. In one aneurysm studied 8 days following treatment with Matrix coils, no difference was noted compared to aneurysms treated with bare platinum coils. In another aneurysm examined 6 months following packing with Matrix coils, the histologic changes support the hypothesis that the biologically active polymer may accelerate aneurysm healing.
本研究旨在评估使用裸铂微线圈或生物活性微线圈治疗的动脉瘤内组织化程度及纤维细胞组织发育情况。
在治疗后1 - 18天内尸检取出12个动脉瘤，另外在治疗后2 - 3个月取出2个。在治疗后6个月至3年手术取出4个动脉瘤。1个在治疗后8天取出的动脉瘤和另1个在治疗后6个月取出的动脉瘤用生物活性（Matrix）微线圈治疗；其他16个用裸铂（ Guglielmi可解脱微线圈；GDCs）治疗。所有标本均包埋于塑料中，用苏木精 - 伊红和弹性蛋白染色，并用光学显微镜检查。
所有在3周内取出的标本均显示动脉瘤内血栓形成，无论使用何种类型的微线圈，颈部均无组织化或纤维化组织形成的迹象。在接受GDC治疗的动脉瘤中，在2 - 3个月内观察到早期血栓组织化的证据，在2 - 3年时出现完整但不完全的纤维细胞反应以及残留血栓。在接受Matrix治疗的标本中，动脉瘤腔在6个月时完全被肉芽组织填充，对应仍在进行的纤维细胞反应，包括新形成的血管、平滑肌细胞和胶原沉积，无残留血栓迹象。
我们的结果表明，使用裸铂微线圈治疗的动脉瘤血栓组织化直到治疗后期才会发生，并且可能多年都不完全。在用Matrix微线圈治疗8天后研究的1个动脉瘤中，与用裸铂微线圈治疗的动脉瘤相比未发现差异。在用Matrix微线圈填塞6个月后检查的另1个动脉瘤中，组织学变化支持生物活性聚合物可能加速动脉瘤愈合这一假说。
