Ionita Ciprian N, Paciorek Ann M, Dohatcu Andreea, Hoffmann Kenneth R, Bednarek Daniel R, Kolega John, Levy Elad I, Hopkins L Nelson, Rudin Stephen, Mocco J Duffy
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Stroke. 2009 Mar;40(3):959-65. doi: 10.1161/STROKEAHA.108.524124. Epub 2009 Jan 8.
Development of hemodynamic modifying devices to treat intracranial aneurysms is an active area of research. The asymmetrical vascular stent (AVS), a stent containing a low-porosity patch, is such device. We evaluate AVS efficacy in an in vivo intracranial aneurysm model.
We created 24 elastase rabbit model aneurysms: 13 treated with the AVS, 5 treated with standard coronary stents, and 6 untreated controls. Four weeks after treatment, aneurysms underwent follow-up angiography, cone-beam micro-CT, histological evaluation, and selective electron microscopy scanning.
Four rabbits died early in the study: 3 during AVS treatment and 1 control (secondary to intraprocedural vessel injury and an unrelated tumor, respectively). AVS-treated aneurysms exhibited very weak or no aneurysm flow immediately after treatment and no flow in all aneurysms at follow-up. Standard stent-treated aneurysms showed flow both after treatment (5/5) and at follow-up (3/5). All control aneurysms remained patent during the study. Micro-CT scans showed: 9 of 9 scanned AVS aneurysms were occluded, 6 of 9 AVS were ideally placed, and 3 of 9 low-porosity region partially covered the aneurysm neck; standard stent-treated aneurysms were 1 of 5 occluded, 2 of 5 patent, and 2 of 5 partially patent. Histology results demonstrated: for AVS-treated aneurysms, advanced thrombus organization in the (9/9); for standard stent-treated aneurysms, (1/4) no thrombus, (2/4) partially thrombosed, and (1/4) fully thrombosed; for control aneurysms (4/4), no thrombus.
The use of AVS shows promise as a viable new therapeutic in intracranial aneurysm treatment. These data encourage further investigation and provide substantial support to the AVS concept.
开发用于治疗颅内动脉瘤的血流动力学调节装置是一个活跃的研究领域。不对称血管支架（AVS），一种带有低孔隙率补片的支架，就是这样一种装置。我们在体内颅内动脉瘤模型中评估AVS的疗效。
我们创建了24个弹性蛋白酶诱导的兔动脉瘤模型：13个用AVS治疗，5个用标准冠状动脉支架治疗，6个作为未治疗的对照。治疗四周后，对动脉瘤进行随访血管造影、锥束微CT、组织学评估和选择性电子显微镜扫描。
4只兔子在研究早期死亡：3只在AVS治疗期间死亡，1只对照兔死亡（分别继发于术中血管损伤和无关肿瘤）。AVS治疗的动脉瘤在治疗后立即显示出非常微弱或无动脉瘤血流，随访时所有动脉瘤均无血流。标准支架治疗的动脉瘤在治疗后（5/5）和随访时（3/5）均显示有血流。所有对照动脉瘤在研究期间均保持通畅。微CT扫描显示：9个扫描的AVS动脉瘤中有9个闭塞，9个AVS中有6个放置理想，9个低孔隙率区域中有3个部分覆盖动脉瘤颈部；标准支架治疗的动脉瘤5个中有1个闭塞，5个中有2个通畅，5个中有2个部分通畅。组织学结果表明：对于AVS治疗的动脉瘤，（9/9）有晚期血栓机化；对于标准支架治疗的动脉瘤，（1/4）无血栓，（2/4）部分血栓形成，（1/4）完全血栓形成；对于对照动脉瘤（4/4），无血栓。
AVS的应用显示出作为颅内动脉瘤治疗一种可行新疗法的前景。这些数据鼓励进一步研究，并为AVS概念提供了大量支持。
