Murayama Y, Viñuela F, Suzuki Y, Do H M, Massoud T F, Guglielmi G, Ji C, Iwaki M, Kusakabe M, Kamio M, Abe T
Endovascular Therapy Service, University of California, Los Angeles, USA.
Neurosurgery. 1997 Jun;40(6):1233-43; discussion 1243-4. doi: 10.1097/00006123-199706000-00024.
Complete anatomic obliteration remains difficult to achieve with endovascular treatment of wide-necked aneurysms using Guglielmi detachable platinum coils (GDCs). Ion implantation is a physicochemical surface modification process resulting from the impingement of a high-energy ion beam. Ion implantation and protein coating were used to alter the surface properties (thrombogenicity, endothelial cellular migration, and adhesion) of GDCs. These modified coils were compared with standard GDCs in the treatment of experimental swine aneurysms.
In an initial study, straight platinum coils were used to compare the acute thrombogenicity of standard and modified coils. Modified coils were coated with albumin, fibronectin, or collagen and underwent Ne+ ion implantation at a dose of 1 x 10(15) ions/cm2 and an energy of 150 keV. Coils were placed in common iliac arteries of 17 swine for 1 hour, to evaluate their acute interactions with circulating blood. In a second study, GDCs were used to treat 34 aneurysms in an additional 17 swine. GDCs were coated with fibronectin, albumin, collagen, laminin, fibrinogen, or vitronectin and then implanted with ions as described above. Bilateral experimental swine aneurysms were embolized with standard GDCs on one side and with ion-implanted, protein-coated GDCs on the other side. The necks of aneurysms were evaluated macroscopically at autopsy, by using post-treatment Day 14 specimens. The dimensions of the orifice and the white fibrous membrane that covered the orifice were measured as the fibrous membrane to orifice proportion. Histopathological evaluation of the neck region was performed by light microscopy and scanning electron microscopy.
Fibronectin-coated, ion-implanted coils showed the greatest acute thrombogenicity (average thrombus weight for standard coils, 1.9 +/- 1.5 mg; weight for fibronectin-coated coils, 8.6 +/- 6.2 mg; P < 0.0001). By using scanning electron microscopy, an intensive blood cellular response was observed on ion-implanted coil surfaces, whereas this was rare with standard coils. At Day 14, greater fibrous coverage of the necks of aneurysms was observed in the ion-implanted coil group (mean fibrous membrane to orifice proportion of 69.8 +/- 6.2% for the ion-implanted coil group, compared with 46.8 +/- 15.9% for the standard coil group; P = 0.0143).
The results of this preliminary experimental study indicate that ion implantation combined with protein coating of GDCs improved cellular adhesion and proliferation. Future application of this technology may provide early wound healing at the necks of embolized, wide-necked, cerebral aneurysms.
使用 Guglielmi 可脱卸铂金线圈（GDC）对宽颈动脉瘤进行血管内治疗时，实现完全解剖学闭塞仍具有挑战性。离子注入是一种由高能离子束撞击产生的物理化学表面改性过程。采用离子注入和蛋白涂层来改变 GDC 的表面特性（血栓形成性、内皮细胞迁移和粘附性）。在治疗实验性猪动脉瘤时，将这些改性线圈与标准 GDC 进行比较。
在初步研究中，使用直铂金线圈比较标准线圈和改性线圈的急性血栓形成性。改性线圈涂有白蛋白、纤连蛋白或胶原蛋白，并以 1×10(15) 离子/cm2 的剂量和 150 keV 的能量进行 Ne+ 离子注入。将线圈置于 17 头猪的髂总动脉中 1 小时，以评估它们与循环血液的急性相互作用。在第二项研究中，使用 GDC 治疗另外 17 头猪的 34 个动脉瘤。GDC 涂有纤连蛋白、白蛋白、胶原蛋白、层粘连蛋白、纤维蛋白原或玻连蛋白，然后按上述方法进行离子注入。双侧实验性猪动脉瘤，一侧用标准 GDC 栓塞，另一侧用离子注入、蛋白涂层的 GDC 栓塞。在尸检时，使用治疗后第 14 天的标本对动脉瘤颈部进行宏观评估。测量孔口尺寸以及覆盖孔口的白色纤维膜，计算纤维膜与孔口的比例。通过光学显微镜和扫描电子显微镜对颈部区域进行组织病理学评估。
纤连蛋白涂层、离子注入的线圈显示出最大的急性血栓形成性（标准线圈的平均血栓重量为 1.9±1.5 mg；纤连蛋白涂层线圈的重量为 8.6±6.2 mg；P<0.0001）。通过扫描电子显微镜观察到，离子注入的线圈表面有强烈的血细胞反应，而标准线圈则很少见。在第 14 天，离子注入线圈组的动脉瘤颈部纤维覆盖程度更高（离子注入线圈组纤维膜与孔口的平均比例为 69.8±6.2%，标准线圈组为 46.8±15.9%；P = 0.0143）。
这项初步实验研究的结果表明，离子注入与 GDC 的蛋白涂层相结合可改善细胞粘附和增殖。该技术的未来应用可能为栓塞的宽颈脑动脉瘤颈部提供早期伤口愈合。
