CAJ | 학술논문

目的评价非粘管性、温敏性液体栓塞材料壳聚糖/甘油磷酸钠(C/GP)栓塞以家猪颅底微血管网(REM)作为颅内动静脉畸形(cAVM)模型的可行性;研究微导管注射C/GP溶液-凝胶系统的方法;观察栓塞效果及REM组织学改变.方法选家猪为实验动物,共24头.直接栓塞一侧REM组12头;行颈总动脉与颈内静脉血管吻合后栓塞双侧REM组12头.栓塞时微导管超选择进入REM,注射C/GP水凝胶直到REM完全不显影为止,2周及6周再行血管造影.6周后组织学检查REM.结果栓塞家猪24头,成功23头.1例栓塞术中发生动物抽搐、死亡;栓塞后血管造影显示REM不再显影,未发生微导管头端与栓塞剂相粘连的情况;2周及6周再行血管造影未发现再通现象.组织学检查:大体观察,水凝胶在REM内均匀弥散,REM栓塞完全,质地较韧.光镜检查:REM管腔内凝胶充填,管壁内膜清晰可见,平滑肌层完整.未见剥脱和血管壁的坏死,血管周围未见炎性反应.结论 C/GP水凝胶不粘管,栓塞REM完全,无血管毒性,易通过不同规格的微导管.初步研究表明非粘管性温敏栓塞材料栓塞cAVM是可行的,为cAVM的血管内治疗提供一种新型的液体栓塞材料.
목적 평개비점관성、온민성액체전새재료각취당/감유린산납(C/GP)전새이가저로저미혈관망(REM)작위로내동정맥기형(cAVM)모형적가행성;연구미도관주사C/GP용액-응효계통적방법;관찰전새효과급REM조직학개변.방법 선가저위실험동물,공24두.직접전새일측REM조12두;행경총동맥여경내정맥혈관문합후전새쌍측REM조12두.전새시미도관초선택진입REM,주사C/GP수응효직도REM완전불현영위지,2주급6주재행혈관조영.6주후조직학검사REM.결과 전새가저24두,성공23두.1례전새술중발생동물추휵、사망;전새후혈관조영현시REM불재현영,미발생미도관두단여전새제상점련적정황;2주급6주재행혈관조영미발현재통현상.조직학검사:대체관찰,수응효재REM내균균미산,REM전새완전,질지교인.광경검사:REM관강내응효충전,관벽내막청석가견,평활기층완정.미견박탈화혈관벽적배사,혈관주위미견염성반응.결론 C/GP수응효불점관,전새REM완전,무혈관독성,역통과불동규격적미도관.초보연구표명비점관성온민전새재료전새cAVM시가행적,위cAVM적혈관내치료제공일충신형적액체전새재료.
Objective To study the safety and feasibility in the embolization of swine rete mirabile (REM) as cerebral arteriovenous malformation (cAVM) with Chitosan/Glycerophosphate(C/GP).To study the method of injectable Chitosan/Glycerophosphate through micmcatheters into swine rete mirabile.To study the embolic effect and the histological changes of rete mirabile.Methods Twenty-four swines were divided into two groups:One group was twelve swines of direct embolism on one side of the REM ; The other group was twelve swines of embolism on two sides of the REM after common carotid artery and internal jugular vein anastomosis.We handled microcatheter into REM,injected chitosan/glycerophosphate until REM occluded.Twenty-four swines were oprerated angiography after two weeks and six weeks.After six weeks the histopathological evaluation of rete mirabile was made.Results The embolism of 24 swines was successful except one swine because of convulsions,stoppage of breathing and death in interventional procedure.The angiography after embolization of REM confirmed that the embolism operation was successful and there was no microcatheter lumen blockage or adhesion.Twenty-four swines were oprerated angiography after two weeks and six weeks and the rete mirabile was still embolized.The histopathological evaluation of the rete mirabile showed that the hydrogels in REM was uniform dispersion and the embolized REM had a hard property.The hydrogel filled lumen of REM.The vascular intima was clearly visible and the smooth muscle layer was intact without vascular wall necrosis and stripped.There was no inflammatory reaction around the blood vessels.Conclusion C/GP hydrogel had the characteristics of nonadhensive catheter,non -toxic,embolism REM,easy to completely through different specifications of the catheter.It was feasible that C/GP with thermosensitive nonadhensive catheter embolize cAVM and it was an ideal embolic material for the treatment of cAVM.