Schmutz F, McAuliffe W, Anderson D M, Elliott J P, Eskridge J M, Winn H R
Department of Radiology, University of Washington, Seattle 98195, USA.
AJNR Am J Neuroradiol. 1997 Aug;18(7):1233-7.
To evaluate the safety of silk as an embolic agent for preoperative embolization of cerebral arteriovenous malformations (AVMs) by assessing the histopathologic changes and hemorrhagic complications associated with its use.
Histopathologic specimens, medical records, and radiologic records of 73 patients with AVMs embolized with silk (alone or in combination with other agents) were reviewed retrospectively. Forty-eight histologic specimens obtained at surgery were analyzed for inflammatory responses and compared with the time interval between embolization and surgery. Postembolization angiograms were assessed for vasculitis and CT scans were reviewed for evidence of hemorrhage after embolization.
There was no angiographic evidence of vasculitis. Histologic evidence of vasculitis was absent or mild in 92% of cases and histologic evidence of perivascular inflammation was absent or mild in 73% of cases. The frequency of histologic changes associated with vasculitis, perivascular inflammation, and vessel necrosis varied with the time interval between embolization and AVM resection. Intracranial hemorrhage, as a direct complication of silk use, occurred in one patient. Another patient had subarachnoid hemorrhage 24 hours after embolization, caused by rupture of a posteroinferior cerebellar artery aneurysm. Intraventricular high-density material appeared on routine postembolization CT scans in two other patients who had intraventricular AVM extension. This high-density material was thought to be contrast extravasation from intrinsically leaky AVM nidus vessels and not frank hemorrhage.
Embolization of AVMs with silk does not result in marked inflammation or increased hemorrhagic complications as compared with other agents.
通过评估与使用丝相关的组织病理学变化和出血并发症，来评价丝作为脑动静脉畸形（AVM）术前栓塞剂的安全性。
回顾性分析73例接受丝（单独或与其他药物联合）栓塞治疗的AVM患者的组织病理学标本、病历和放射学记录。对手术中获取的48份组织学标本进行炎症反应分析，并与栓塞和手术之间的时间间隔进行比较。评估栓塞后血管造影是否存在血管炎，并复查CT扫描以寻找栓塞后出血的证据。
血管造影未发现血管炎证据。92%的病例无或仅有轻度血管炎组织学证据，73%的病例无或仅有轻度血管周围炎症组织学证据。与血管炎、血管周围炎症和血管坏死相关的组织学变化频率随栓塞与AVM切除之间的时间间隔而变化。作为使用丝的直接并发症，1例患者发生颅内出血。另1例患者在栓塞后24小时出现蛛网膜下腔出血，由小脑后下动脉瘤破裂所致。另外2例有脑室内AVM扩展的患者在栓塞后常规CT扫描上出现脑室内高密度物质。这种高密度物质被认为是来自固有渗漏的AVM病灶血管的造影剂外渗，而非明显出血。
与其他药物相比，用丝栓塞AVM不会导致明显炎症或出血并发症增加。
