Neuro Interventional Service, Department of Radiology, Washington Hospital Center, Washington DC, USA.
Neurosurgery. 2011 Apr;68(4):1056-62. doi: 10.1227/NEU.0b013e31820d5396.
If a self-expanding stent has been placed during endovascular treatment of an aneurysm and subsequently an open aneurysm surgery becomes necessary in the same or an adjacent area, is it possible and safe to obtain proximal control by placing a temporary clip on the artery at a point where it contains the stent?
To evaluate the effect of temporary clip application to 3 separate stent systems in an in vitro flow model with the stated hypothesis that clip application to these stents will result in permanent stent deformation.
This is an in vitro flow model study using an accepted synthetic blood vessel substitute. The Neuroform(3) (Boston Scientific), Enterprise (Cordis/Codman), and Pipeline (ev3) stents were deployed within the flow model; temporary clips were applied; and angiographic measurements subsequently made.
Two 4 × 30-mm Neuroform(3) stents, two 4.5 × 28-mm Enterprise stents, and two 3.75 × 20-mm Pipeline stents were successfully deployed and clipped repeatedly (4 iterations). Two- and 3-dimensional angiograms were obtained. After repeated clip occlusion, the Neuroform(3) and Enterprise stents returned to their original configuration and diameter. Clip application to both also resulted in immediate flow arrest. In contrast, initial clip application to the Pipeline stents did not result in flow arrest, but the second single clip application did. The Pipeline stents were also irreversibly deformed after the experimental protocol, with an average luminal diameter reduction of 26.85% (P < .05).
The Neuroform(3) and Enterprise stents responded favorably to temporary clip application, returning to their original diameter after clip removal and showing no sign of permanent structural modification. The Pipeline flow-diverting stent, however, was irreversibly deformed by clip application. These data indicate that temporary clip application to certain stents is possible. Further in vivo study is required.
如果在血管内治疗动脉瘤时放置了自膨式支架，随后在同一部位或相邻部位需要进行开放的动脉瘤手术，是否可以并且安全地通过在包含支架的动脉上放置临时夹来获得近端控制？
在体外血流模型中评估 3 种不同支架系统的临时夹应用效果，假设夹应用于这些支架会导致永久性支架变形。
这是一项使用公认的合成血管替代物的体外血流模型研究。Neuroform（3）（波士顿科学公司）、Enterprise（Cordis/Codman）和 Pipeline（ev3）支架在血流模型中进行了部署；应用临时夹；随后进行血管造影测量。
成功地重复部署了两个 4×30mm 的 Neuroform（3）支架、两个 4.5×28mm 的 Enterprise 支架和两个 3.75×20mm 的 Pipeline 支架，并进行了反复夹闭（4 次迭代）。获得了二维和三维血管造影图像。在反复夹闭后，Neuroform（3）和 Enterprise 支架恢复到原始形态和直径。夹闭也立即导致了血流停止。相比之下，最初对 Pipeline 支架的夹闭并没有导致血流停止，但第二次单独夹闭则导致了这种情况。在实验方案后，Pipeline 支架也发生了不可逆的变形，管腔直径平均减少了 26.85%（P<.05）。
Neuroform（3）和 Enterprise 支架对临时夹应用反应良好，在夹闭去除后恢复到原始直径，没有永久性结构改变的迹象。然而，Pipeline 血流导向支架在夹闭后发生了不可逆的变形。这些数据表明，某些支架的临时夹应用是可行的。需要进一步的体内研究。
