Macdonald R L, Mojtahedi S, Johns L, Kowalczuk A
Section of Neurosurgery, University of Chicago Medical Center, Ill 60637, USA.
Stroke. 1998 Feb;29(2):478-85; discussion 485-6. doi: 10.1161/01.str.29.2.478.
Endovascular treatments for aneurysms are being used more frequently in patients in the absence of a large body of information on their histopathological effects. This study determined the efficacy and histopathological effects of treatment of experimental aneurysms with Guglielmi detachable coils (GDC) or cellulose acetate polymer (CAP).
Fourteen dogs had 13 terminal and 30 sidewall aneurysms created with venous pouches sutured to the cervical carotid arteries. Two weeks later, dogs had angiography followed by randomization to no treatment (n=2) or to aneurysm occlusion with GDC (n=4) or CAP (n=6). Two months later, angiography was repeated, animals were killed, and aneurysms were excised, fixed, photographed, and examined by light and electron microscopy.
Two dogs were excluded because of common carotid artery occlusion at 2-week angiography. There were 11 terminal and 16 sidewall aneurysms available for treatment. The rate of spontaneous thrombosis of untreated aneurysms was 0% (0/5). Treatment with GDC showed complete terminal and sidewall aneurysm obliteration rates of 33% (1/3) and 80% (4/5), respectively. Greater than 90% occlusion occurred in the remaining cases. There were no parent or branch artery occlusions. Treatment with CAP showed complete terminal and sidewall aneurysm obliteration rates of 20% (1/5) and 0% (0/5), respectively, and incomplete sidewall aneurysm obliteration in 1 of 5 cases. Aneurysms reformed at 2 months in 2 of 5 terminal and 1 of 5 sidewall cases. There were parent or branch artery occlusions with CAP in 2 and 4 cases, respectively. The rate of aneurysm occlusion was significantly lower and the rate of arterial occlusion significantly higher with CAP than with GDC (P<.05). Histopathology showed complete endothelialization across the orifice of the aneurysm successfully treated with CAP, whereas aneurysms treated with GDC were significantly more likely to show fresh or organizing thrombus without complete endothelialization (P<.05).
It is concluded that both treatments have limitations. Complete packing of aneurysms with GDC obliterates the aneurysm, but endothelialization does not always occur within 2 months. There are substantial problems with CAP. It is thrombogenic and carries a higher risk of causing arterial thrombosis. Even if an aneurysm is successfully obliterated initially with CAP, the CAP may disappear, leaving the aneurysm completely untreated.
在缺乏大量关于血管内治疗动脉瘤组织病理学效应信息的情况下，动脉瘤的血管内治疗在患者中应用得越来越频繁。本研究确定了用 Guglielmi 可脱性弹簧圈（GDC）或醋酸纤维素聚合物（CAP）治疗实验性动脉瘤的疗效和组织病理学效应。
14 只犬通过将静脉囊缝合至颈总动脉制造了 13 个终末动脉瘤和 30 个侧壁动脉瘤。两周后，对犬进行血管造影，然后随机分为不治疗组（n = 2）、用 GDC 闭塞动脉瘤组（n = 4）或用 CAP 闭塞动脉瘤组（n = 6）。两个月后，重复血管造影，处死动物，切除动脉瘤，固定、拍照，并进行光镜和电镜检查。
2 只犬因在两周血管造影时颈总动脉闭塞而被排除。有 11 个终末动脉瘤和 16 个侧壁动脉瘤可供治疗。未治疗动脉瘤的自发血栓形成率为 0%（0/5）。用 GDC 治疗时，终末和侧壁动脉瘤的完全闭塞率分别为 33%（1/3）和 80%（4/5）。其余病例闭塞率大于 90%。未出现载瘤动脉或分支动脉闭塞。用 CAP 治疗时，终末和侧壁动脉瘤的完全闭塞率分别为 20%（1/5）和 0%（0/5），5 例中有 1 例侧壁动脉瘤闭塞不完全。5 个终末动脉瘤中有 2 个和 5 个侧壁动脉瘤中有 1 个在两个月时动脉瘤复发。用 CAP 治疗分别有 2 例和 4 例出现载瘤动脉或分支动脉闭塞。与 GDC 相比，CAP 治疗的动脉瘤闭塞率显著更低，动脉闭塞率显著更高（P <.05）。组织病理学显示，用 CAP 成功治疗的动脉瘤孔口完全内皮化，而用 GDC 治疗的动脉瘤更易出现新鲜或机化血栓且无完全内皮化（P <.05）。
得出的结论是两种治疗方法都有局限性。用 GDC 完全填塞动脉瘤可使动脉瘤闭塞，但内皮化在两个月内并非总能发生。CAP 存在诸多问题。它具有血栓形成性，导致动脉血栓形成的风险更高。即使动脉瘤最初用 CAP 成功闭塞，CAP 也可能消失，使动脉瘤完全未得到治疗。
