Ionita Ciprian N, Paciorek Ann M, Hoffmann Kenneth R, Bednarek Daniel R, Yamamoto Junichi, Kolega John, Levy Elad I, Hopkins L Nelson, Rudin Stephen, Mocco J
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14209, USA.
Stroke. 2008 Jul;39(7):2105-13. doi: 10.1161/STROKEAHA.107.503862. Epub 2008 Apr 24.
Intracranial aneurysm (IA) treatment through hemodynamic modification with novel stent designs is a burgeoning area of research. We present a feasibility study for a new low-porosity patch-containing stent designed to treat intracranial aneurysms. The device is deployed so the patch covers the aneurysm neck ensuring strong flow diversion away from the aneurysm while keeping a low probability of occlusion of perforating vessels.
We created 17 side-wall aneurysms in 6 dogs, 2 per carotid artery if animal size permitted. Twelve proximal aneurysms were treated with AVSs: 5 distal aneurysms were untreated, serving as controls against self-thrombosis; 7 treated aneurysms were fully-covered; and 5 were partially-covered. After 4 weeks, a final angiogram was performed and aneurysms were explanted. Angiograms acquired pre- and posttreatment and at 4-week follow-up were analyzed quantitatively using normalized time-density curves (NTDC). Cone-beam micro-CT and histological specimen analysis were then performed.
Posttreatment, NTDC average peaks dropped to 45% of initial values for the partially-covered aneurysms and 78% for the fully-covered aneurysms. Cone-beam micro-CT imaging performed at 4 weeks posttreatment showed partial thrombosis in 4 of 5 partially-covered aneurysms and complete thrombosis in all fully-covered aneurysms. Histology revealed neointimal coverage of all asymmetrical patch regions and thrombus formation in both fully- and partially-covered aneurysms. Four-week follow-up was not done for 1 animal (2 controls, 2 treated) that expired because of groin hemorrhage and for another animal (1 aneurysm) with an occluded carotid.
We demonstrate aneurysmal blood flow diversion using a new low-porosity patch-containing asymmetrical vascular stent in a canine side-wall aneurysm model. Overall results are encouraging and support continued AVS development.
采用新型支架设计通过血流动力学改变来治疗颅内动脉瘤（IA）是一个新兴的研究领域。我们开展了一项关于一种新型含低孔隙率补片的支架治疗颅内动脉瘤的可行性研究。该装置的部署方式是使补片覆盖动脉瘤颈部，确保强大的血流改道，使血流远离动脉瘤，同时保持穿支血管闭塞的可能性较低。
我们在6只犬身上制造了17个侧壁动脉瘤，如果动物体型允许，每条颈动脉制造2个。12个近端动脉瘤用AVS进行治疗：5个远端动脉瘤未治疗，作为防止自发血栓形成的对照；7个治疗的动脉瘤被完全覆盖；5个被部分覆盖。4周后，进行最终血管造影并取出动脉瘤。使用标准化时间-密度曲线（NTDC）对治疗前、治疗后及4周随访时获取的血管造影进行定量分析。然后进行锥束微CT和组织学标本分析。
治疗后，部分覆盖的动脉瘤NTDC平均峰值降至初始值的45%，完全覆盖的动脉瘤降至78%。治疗后4周进行的锥束微CT成像显示，5个部分覆盖的动脉瘤中有4个出现部分血栓形成，所有完全覆盖的动脉瘤均出现完全血栓形成。组织学显示所有不对称补片区域均有新生内膜覆盖，完全覆盖和部分覆盖的动脉瘤均有血栓形成。1只动物（2个对照，2个治疗）因腹股沟出血死亡，另1只动物（1个动脉瘤）颈动脉闭塞，未对其进行4周随访。
我们在犬侧壁动脉瘤模型中使用一种新型含低孔隙率补片的不对称血管支架证明了动脉瘤血流改道。总体结果令人鼓舞，支持AVS的持续研发。
