Reul J, Spetzger U, Weis J, Sure U, Gilsbach J M, Thron A
Department of Neuroradiology, University Hospital Rheinisch-Westfälische Technische Hochshule Aachen, Germany.
Neurosurgery. 1997 Nov;41(5):1160-5; discussion 1165-8. doi: 10.1097/00006123-199711000-00028.
This study was designed to assess the intraluminal biological changes after endovascular coil occlusion of arterial aneurysms with detachable coils, to analyze the relationship between histological occlusion and mechanical packing density, and to evaluate the influence of perioperative anticoagulation on the occlusion rate.
In rabbits, 30 microsurgically produced arterial bifurcation aneurysms were occluded with coils (18 with platinum coils, electrically detached; 12 with tungsten coils, mechanically detached). Coils were placed until no further coils fit into the aneurysmal lumen and it was no longer filled with radiographic contrast material. The individual degree of occlusion was then determined by the "packing density" on the angiograms. Complete occlusion was considered only if no neck remnant was visible on the films. Anticoagulation during and 2 days after the treatment was performed in 11 cases. After an observation period ranging from 3 to 6 months, angiographic and histological analyses were performed to obtain control data.
Complete occlusion was achieved in 9 cases, subtotal occlusion (i.e., > 95% occlusion, residual filling at the neck of the aneurysm) in 10 cases, and partial occlusion in 11 cases. Angiographically documented recanalization was detected in 14 aneurysms. In the remaining 16 aneurysms, the initially documented angiographic results were unchanged. A discrepancy between angiographic and pathological findings was frequently observed. Five of nine angiographically completely occluded aneurysms were recanalized. Endothelial-like tissue at the orifice of the aneurysm was able to be observed in only four of the nine initially completely occluded aneurysms.
The results suggest that even dense packing does not always guarantee permanent occlusion, although there was a positive relationship between packing density and occlusion rate. Anticoagulation did not have any negative effect on the results.
本研究旨在评估使用可脱卸弹簧圈血管内栓塞动脉动脉瘤后的腔内生物学变化，分析组织学闭塞与机械填充密度之间的关系，并评估围手术期抗凝对闭塞率的影响。
在兔身上，通过显微手术制造30个动脉分叉处动脉瘤，并用弹簧圈进行栓塞（18个用铂制弹簧圈，电脱卸；12个用钨制弹簧圈，机械脱卸）。持续放置弹簧圈，直到动脉瘤腔内无法再容纳更多弹簧圈且不再充满造影剂。然后通过血管造影上的“填充密度”确定个体闭塞程度。只有在片子上看不到颈部残余时才认为是完全闭塞。11例在治疗期间及治疗后2天进行抗凝。经过3至6个月的观察期后，进行血管造影和组织学分析以获得对照数据。
9例实现完全闭塞，10例为次全闭塞（即闭塞>95%，动脉瘤颈部有残余填充），11例为部分闭塞。在14个动脉瘤中检测到血管造影记录的再通。在其余16个动脉瘤中，最初记录的血管造影结果未改变。经常观察到血管造影和病理结果之间存在差异。9个血管造影完全闭塞的动脉瘤中有5个发生再通。在最初9个完全闭塞的动脉瘤中，只有4个在动脉瘤开口处能观察到内皮样组织。
结果表明，尽管填充密度与闭塞率之间存在正相关关系，但即使致密填充也并非总能保证永久性闭塞。抗凝对结果没有负面影响。
