Geremia G, Bakon M, Brennecke L, Haklin M, Silver B
Department of Diagnostic Radiology, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill 60612, USA.
AJNR Am J Neuroradiol. 1997 Feb;18(2):271-7.
To determine the efficacy of silicone-covered metallic stents in the treatment of experimentally created carotid-jugular fistulas.
Carotid-jugular fistulas were surgically constructed in six mongrel dogs. Silicone-coated, self-expanding metallic stents were placed across the fistula holes within the carotid artery, and carotid angiography was performed before, immediately after, and 4 and 8 weeks after stent placement. Fistula specimens were resected 2 months after stent placement and analyzed by means of gross and light microscopy.
Angiography revealed complete closure of all fistulas immediately after stent deployment. The fistulas remained closed and all carotid arteries remained patent. Marked stenosis within the carotid lumen was seen along the proximal and distal ends of the stents. Gross and micropathologic specimens of the carotid-jugular fistulas revealed fibrous connective tissue and collagen across the fistula holes. Proliferative fibrous connective tissue, collagen, and fibromyoblasts were located at either end of the stents. The wires of the stents indented the intraluminal surface of the carotid arteries.
Silicone-covered stents were effective in closing all experimentally created carotid-jugular fistulas. With further refinements and variations in technique, covered stents may prove a viable alternative to current endovascular devices.
确定硅酮涂层金属支架治疗实验性建立的颈静脉瘘的疗效。
在6只杂种犬身上手术构建颈静脉瘘。将硅酮涂层的自膨式金属支架置于颈动脉内的瘘口处，并在支架置入前、置入后即刻、置入后4周和8周进行颈动脉血管造影。在支架置入2个月后切除瘘管标本，进行大体和光学显微镜分析。
血管造影显示支架置入后所有瘘管立即完全闭合。瘘管保持闭合，所有颈动脉保持通畅。在支架的近端和远端可见颈动脉腔内明显狭窄。颈静脉瘘的大体和微观病理标本显示瘘口处有纤维结缔组织和胶原。增殖性纤维结缔组织、胶原和成纤维肌细胞位于支架的两端。支架的金属丝使颈动脉的管腔内表面出现压痕。
硅酮涂层支架可有效闭合所有实验性建立的颈静脉瘘。随着技术的进一步改进和变化，覆膜支架可能成为当前血管内装置的可行替代方案。
