Grabitz R G, Freudenthal F, Sigler M, Seghaye M C, Boosfeld C, von Bernuth G
Department of Pediatric Cardiology and Interdisciplinary Center of Clinical Research on Biomaterials, Aachen University of Technology, Germany.
Invest Radiol. 1997 Oct;32(10):636-43. doi: 10.1097/00004424-199710000-00009.
Several devices have been suggested and tested for interventional closure of the persistent ductus arteriosus. Coils were found effective only in small ducts due to their lack of maneuverability and physical limitation of grip forces leading to risk of embolization. The authors evaluated the feasibility to place single coils with selectively enhanced stiffness into high shunting ductus arteriosus, the coils being deployed and controlled through a veno-arterial loop in a bovine model.
"Double-cone" shaped, stainless steel coils with enhanced stiffness of the outer rings were mounted on either end on a nitinol core wire. A snap-in mechanism attaches the coil to this delivery wire and is freed by a pusher system of coiled steel wire that is advanced over the core wire. Forming a veno-arterial loop across the patent ductus allows for repositioning into the pulmonary artery or aortic catheter. A chronic lamb model of large patent ductus arteriosus (PDAs) (> or = 9 mm) was used in which ductus patency was secured by a protocol of repetitive angioplasties. Different systems (n = 10) were placed having retrieved the previous coil by a snare after definitive release.
Placement of coils was possible in all 10 attempts. The coils were pulled back into the catheters between five and eight times before definitive release.
The device allows controlled placement of single coils in our model of large PDAs and may lead the way to overcome previous limitations of coils. Clinical trials are warranted.
已经提出并测试了几种用于介入性闭合动脉导管未闭的装置。由于其缺乏可操作性以及握持力的物理限制导致存在栓塞风险，发现线圈仅对小导管有效。作者评估了将具有选择性增强刚度的单个线圈放置到高分流动脉导管未闭中的可行性，这些线圈通过牛模型中的静脉 - 动脉环进行部署和控制。
将外圈刚度增强的“双锥”形不锈钢线圈安装在镍钛诺芯线上的两端。一种卡入机构将线圈连接到该输送导丝上，并通过在芯线上推进的盘绕钢丝推动系统释放。通过动脉导管未闭形成静脉 - 动脉环允许重新定位到肺动脉或主动脉导管中。使用大型动脉导管未闭（PDA）（≥9mm）的慢性羔羊模型，其中通过重复血管成形术方案确保导管通畅。在最终释放后，用圈套器取回先前的线圈，放置不同的系统（n = 10）。
在所有10次尝试中都可以放置线圈。在最终释放之前，线圈被拉回到导管中五到八次。
该装置允许在我们的大型PDA模型中对单个线圈进行可控放置，并可能引领克服线圈先前局限性的道路。有必要进行临床试验。
