Ionita Ciprian N, Dohatcu Andreea, Sinelnikov Andrey, Sherman Jason, Keleshis Christos, Paciorek Ann M, Hoffmann K R, Bednarek D R, Rudin S
Toshiba Stroke Research Center, SUNY-University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA.
Proc SPIE Int Soc Opt Eng. 2009 Jan 1;7262:72621H1-72621H10. doi: 10.1117/12.812628.
Image-guided endovascular intervention (EIGI), using new flow modifying endovascular devices for intracranial aneurysm treatment is an active area of stroke research. The new polyurethane-asymmetric vascular stent (P-AVS), a vascular stent partially covered with a polyurethane-based patch, is used to cover the aneurysm neck, thus occluding flow into the aneurysm. This study involves angiographic imaging of partially covered aneurysm orifices. This particular situation could occur when the vascular geometry does not allow full aneurysm coverage. Four standard in-vivo rabbit-model aneurysms were investigated; two had stent patches placed over the distal region of the aneurysm orifice while the other two had stent patches placed over the proximal region of the aneurysm orifice. Angiographic analysis was used to evaluate aneurysm blood flow before and immediately after stenting and at four-week follow-up. The treatment results were also evaluated using histology on the aneurysm dome and electron microscopy on the aneurysm neck. Post-stenting angiographic flow analysis revealed aneurysmal flow reduction in all cases with faster flow in the distally-covered case and very slow flow and prolonged pooling for proximal-coverage. At follow-up, proximally-covered aneurysms showed full dome occlusion. The electron microscopy showed a remnant neck in both distally-placed stent cases but complete coverage in the proximally-placed stent cases. Thus, direct flow (impingement jet) removal from the aneurysm dome, as indicated by angiograms in the proximally-covered case, was sufficient to cause full aneurysm healing in four weeks; however, aneurysm healing was not complete for the distally-covered case. These results support further investigations into the treatment of aneurysms by flow-modification using partial aneurysm-orifice coverage.
图像引导下的血管内介入治疗（EIGI），使用新型血流改型血管内装置治疗颅内动脉瘤是卒中研究的一个活跃领域。新型聚氨酯不对称血管支架（P-AVS），一种部分覆盖聚氨酯基补片的血管支架，用于覆盖动脉瘤颈部，从而阻断流入动脉瘤的血流。本研究涉及部分覆盖动脉瘤口的血管造影成像。当血管几何形状不允许完全覆盖动脉瘤时，可能会出现这种特殊情况。研究了四只标准的体内兔模型动脉瘤；两只在动脉瘤口远端区域放置了支架补片，另外两只在动脉瘤口近端区域放置了支架补片。血管造影分析用于评估支架置入前、置入后即刻以及四周随访时的动脉瘤血流情况。还使用动脉瘤穹窿的组织学检查和动脉瘤颈部的电子显微镜检查来评估治疗结果。支架置入后的血管造影血流分析显示，所有病例的动脉瘤血流均减少，远端覆盖病例的血流较快，近端覆盖病例的血流非常缓慢且有长时间的血流淤滞。随访时，近端覆盖的动脉瘤显示穹窿完全闭塞。电子显微镜检查显示，远端放置支架的两个病例均有残余颈部，但近端放置支架的病例完全覆盖。因此，如近端覆盖病例血管造影所示，从动脉瘤穹窿去除直接血流（冲击射流）足以在四周内使动脉瘤完全愈合；然而，远端覆盖病例的动脉瘤愈合并不完全。这些结果支持进一步研究通过部分动脉瘤口覆盖进行血流改型治疗动脉瘤。
