Reul J, Weis J, Spetzger U, Konert T, Fricke C, Thron A
Department of Neuroradiology, University Hospital, Aachen, Germany.
AJNR Am J Neuroradiol. 1997 Jan;18(1):35-42.
To evaluate the long-term outcome of endovascular occlusion of arterial aneurysms effected with metal coils.
Microsurgical methods were used to produce carotid bifurcation aneurysms in 20 rabbits and the radiologic and histologic changes were examined. Eight of these aneurysms were occluded with electrically detachable platinum coils (Guglielmi detachable coils [GDCs] and nine were treated with mechanically detachable tungsten coils (mechanical detachable system [MDS]). Three aneurysms remained untreated and served as controls. One animal died of embolic complications 12 hours after endovascular treatment. After observation periods of 3 to 6 months, the remaining animals were examined by intraarterial digital subtraction angiography and subsequent fixation and light and electron microscopy.
Large open spaces without signs of thrombosis were found between the loops of the coil baskets in 12 aneurysms (six treated with GDCs and six treated with MDS) regardless of the observation period. In very densely packed aneurysms (four cases with complete occlusion as determined by angiographic criteria), the coil surfaces were for the most part covered by thin cell layers; however, complete endothelialization was never seen. In aneurysms with an initial partial occlusion of 70% to 90%, coil compaction and/or recanalization was a consistent finding. A comparison of the radiologic findings with the histologic aspect revealed that the degree of occlusion was often overrated on the radiographs (in eight of 17 cases). In general, the fibrous tissue reaction appeared to be slightly more pronounced in aneurysms occluded with tungsten coils.
Platinum and tungsten coils were not always effective in causing endoluminal thrombosis leading to long-term occlusion by organized thrombus.
评估使用金属线圈进行动脉动脉瘤血管内闭塞的长期效果。
采用显微外科方法在20只兔子身上制造颈总动脉分叉动脉瘤，并检查其放射学和组织学变化。其中8个动脉瘤用可电解脱卸铂金线圈（ Guglielmi可脱卸线圈[GDC]）闭塞，9个用机械可脱卸钨线圈（机械可脱卸系统[MDS]）治疗。3个动脉瘤未治疗作为对照。1只动物在血管内治疗后12小时死于栓塞并发症。经过3至6个月的观察期后，对其余动物进行动脉内数字减影血管造影检查，随后进行固定以及光镜和电镜检查。
无论观察期如何，在12个动脉瘤（6个用GDC治疗，6个用MDS治疗）的线圈篮环之间发现了大的开放空间，没有血栓形成的迹象。在非常致密填充的动脉瘤（4例根据血管造影标准确定为完全闭塞）中，线圈表面大部分被薄细胞层覆盖；然而，从未见过完全内皮化。在初始部分闭塞率为70%至90%的动脉瘤中，线圈压实和/或再通是一个一致的发现。放射学结果与组织学表现的比较显示，在X线片上闭塞程度常常被高估（17例中有8例）。一般来说，在用钨线圈闭塞的动脉瘤中，纤维组织反应似乎略为明显。
铂金和钨线圈在导致腔内血栓形成并通过机化血栓实现长期闭塞方面并不总是有效。
