Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.
AJNR Am J Neuroradiol. 2011 Sep;32(8):1399-407. doi: 10.3174/ajnr.A2548. Epub 2011 Jul 14.
The self-expanding V-POD is a second-generation flow-diverting device with a low-porosity PTFE patch on a self-expanding microstent. The authors evaluated this device for the treatment of elastase-induced aneurysms in rabbits.
Three V-POD types (A, circumferential patch closed-cell stent [n = 9]; B, asymmetric patch closed-cell stent [n = 7]; and C, asymmetric patch open-cell stent [n = 4]) were evaluated by using angiography, conebeam micro-CT, histology, and SEM. Aneurysm flow modifications were expressed in terms of immediate poststent/prestent ratios of maximum CA volume entering the aneurysm dome tracked on procedural angiograms. Flow modifications were correlated with 4 weeks' follow-up angiographic, micro-CT, histologic, and SEM results.
Mechanical stent-deployment difficulties in 4 aneurysms (1 type A; 3 type B) led to suboptimal results and exclusion from analysis. Of the remaining 16 aneurysms, 4-week post-treatment angiograms showed no aneurysm filling in 10 (63%), 3 (∼19%) had no filling with a small remnant neck, and 3 (∼19%) had <0.25 filling. Successfully treated aneurysms (n = 16) demonstrated an immediate poststent/prestent CA maximum volume ratio of 0.13 ± 0.18% (0.0%-0.5%). Favorable contrast-flow modification on immediate angiography after deployment correlated significantly with aneurysm occlusion on follow-up angiography, micro-CT, and histology. The occlusion percentage derived from micro-CT was 96 ± 6.8%. Histology indicated advanced healing (grade ≥3) in the aneurysm dome in 13 of 16 cases. SEM revealed 15 of 16 stents in an advanced state of endothelialization.
This study showed the feasibility and effectiveness of V-POD for aneurysm healing in a rabbit elastase model.
自膨式 V-POD 是一种第二代血流导向装置，在自膨微支架上有一个低孔隙率的聚四氟乙烯补片。作者评估了该装置在兔弹性蛋白酶诱导动脉瘤中的治疗效果。
通过血管造影、锥形束微 CT、组织学和扫描电子显微镜（SEM）评估了三种 V-POD 类型（A 型，环形补片闭孔支架[9 例]；B 型，不对称补片闭孔支架[7 例]；C 型，不对称补片开孔支架[4 例]）。通过程序性血管造影术中跟踪动脉瘤瘤顶进入最大 CA 容积的即刻支架前后比来表示动脉瘤血流的改变。血流改变与 4 周后的血管造影、微 CT、组织学和 SEM 结果相关。
在 4 个动脉瘤（1 个 A 型；3 个 B 型）中，由于机械性支架展开困难，结果不理想，被排除在分析之外。在其余 16 个动脉瘤中，4 周后治疗的血管造影显示 10 个（63%）动脉瘤无充盈，3 个（约 19%）无充盈但有小残余颈部，3 个（约 19%）<0.25 充盈。成功治疗的动脉瘤（n=16）的即刻支架前后最大 CA 容积比为 0.13±0.18%（0.0%-0.5%）。支架置入后即刻血管造影显示的良好对比血流改变与随访血管造影、微 CT 和组织学上的动脉瘤闭塞显著相关。微 CT 计算的闭塞率为 96±6.8%。组织学显示 16 例中有 13 例在动脉瘤瘤顶有高级愈合（等级≥3）。SEM 显示 16 个支架中有 15 个处于内皮化的高级状态。
本研究显示了 V-POD 在兔弹性蛋白酶模型中用于动脉瘤愈合的可行性和有效性。
