Weiss Clifford R, Fu Yingli, Beh Cyrus, Hu Charles, Kedziorek Dorota, Shin Eun-Ji, Anders Robert A, Arepally Aravind, Kraitchman Dara L
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Vasc Interv Radiol. 2020 Sep;31(9):1483-1491. doi: 10.1016/j.jvir.2020.04.038. Epub 2020 Aug 14.
To examine safety and efficacy of bariatric arterial embolization (BAE) with x-ray-visible embolic microspheres (XEMs) and an antireflux catheter in swine.
BAE with selective infusion of XEMs (n = 6) or saline (n = 4, control) into gastric fundal arteries was performed under x-ray guidance. Weight and plasma hormone levels were measured at baseline and weekly for 4 weeks after embolization. Cone-beam CT images were acquired immediately after embolization and weekly for 4 weeks. Hormone-expressing cells in the stomach were assessed by immunohistochemical staining.
BAE pigs lost weight 1 week after embolization followed by significantly impaired weight gain relative to control animals (14.3% vs 20.9% at 4 weeks, P = .03). Plasma ghrelin levels were significantly lower in BAE pigs than in control animals (1,221.6 pg/mL vs 1,706.2 pg/mL at 4 weeks, P < .01). XEMs were visible on x-ray and cone-beam CT during embolization, and radiopacity persisted over 4 weeks (165.5 HU at week 1 vs 158.5 HU at week 4, P = .9). Superficial mucosal ulcerations were noted in 1 of 6 BAE animals. Ghrelin-expressing cell counts were significantly lower in the gastric fundus (17.7 vs 36.8, P < .00001) and antrum (24.2 vs 46.3, P < .0001) of BAE pigs compared with control animals. Gastrin-expressing cell counts were markedly reduced in BAE pigs relative to control animals (98.5 vs 127.0, P < .02). Trichrome staining demonstrated significantly more fibrosis in BAE animals compared with control animals (13.8% vs 8.7%, P < .0001).
XEMs enabled direct visualization of embolic material during and after embolization. BAE with XEMs and antireflux microcatheters was safe and effective.
研究使用X线显影栓塞微球（XEMs）和抗反流导管进行减重动脉栓塞术（BAE）在猪身上的安全性和有效性。
在X线引导下，对胃底动脉进行BAE，向其中选择性注入XEMs（n = 6）或生理盐水（n = 4，对照组）。在栓塞前的基线水平以及栓塞后4周每周测量体重和血浆激素水平。栓塞后立即以及之后4周每周采集锥形束CT图像。通过免疫组织化学染色评估胃中表达激素的细胞。
BAE猪在栓塞后1周体重减轻，随后相对于对照动物体重增加明显受损（4周时分别为14.3%和20.9%，P = 0.03）。BAE猪的血浆胃饥饿素水平显著低于对照动物（4周时分别为1221.6 pg/mL和1706.2 pg/mL，P < 0.01）。在栓塞过程中，XEMs在X线和锥形束CT上可见，并且造影剂不透明度在4周内持续存在（第1周时为165.5 HU，第4周时为158.5 HU，P = 0.9）。6只接受BAE的动物中有1只出现浅表黏膜溃疡。与对照动物相比，BAE猪胃底（分别为17.7和36.8，P < 0.00001）和胃窦（分别为24.2和46.3，P < 0.0001）中表达胃饥饿素的细胞计数显著降低。与对照动物相比，BAE猪中表达胃泌素的细胞计数明显减少（分别为98.5和127.0，P < 0.02）。三色染色显示BAE动物的纤维化程度明显高于对照动物（分别为13.8%和8.7%，P < 0.0001）。
XEMs能够在栓塞过程中和栓塞后直接观察到栓塞材料。使用XEMs和抗反流微导管进行BAE是安全有效的。
