双介入治疗颈部创伤性动脉瘤间异物:动物实验研究

目的通过动物实验探讨双介入治疗颈部创伤性动脉瘤间异物的可行性及效果。方法选取5只2岁健康比格犬,对其右颈部构建创伤性动脉瘤间异物模型(研究侧),左侧颈部采用直接断针刺入、留置方法构建颈动脉旁软组织异物模型(对照侧)。对研究侧,在直接经7F血管鞘颈动脉内植入可降解覆膜支架封堵瘤口的同时,于透视下经皮经软组织钳取动脉瘤间异物;对照侧则采用传统介入方法,在颈动脉内导丝定位透视下经皮经软组织钳取异物。以DSA评价介入治疗效果,并通过CTA或MRA进行随访。结果研究侧直接经鞘法颈动脉内支架植入技术成功率为100%(5/5);异物取出后动脉瘤均有不同程度出血,覆膜支架释放后均有效止血。术后3个月内随访研究侧颈动脉局部均呈轻度或中度狭窄,未见明显内瘘及动脉瘤复发。对照侧传统介入方法取出异物的技术成功率亦为100%(5/5),未见颈动脉狭窄等改变。结论可降解覆膜支架辅助双介入治疗技术可一站式同时微创取出犬颈部创伤性动脉瘤间异物并封闭动脉瘤口;直接经鞘法可作为可供选择的植入血管内支架的动物实验方法。

Dual intervention for traumatic carotid aneurysm within foreign body: Animal experimentation

Objective To investigate the technological feasibility and effect of a new dual intervention method for traumatic carotid aneurysm penetrated by retained foreign body (FB) through animal experiment. Methods Models of traumatic carotid aneurysm within FB retention were established by surgical vein grafting to the right carotid artery within broken needle penetration (experiment group) in 5 healthy beagle dogs aged about 2 years old. And the left necks of the dogs were modeled by broken needle embedding into soft tissue nearby carotid artery (control group). In experiment group, the degradable covered-stents were directly placed into the parent artery though 7F vascular sheath for plugging aneurysm, and fluoroscopy-guided FB removing using forceps were carried out simultaneously. In control group, it was just performed percutaneous trans-soft-tissue FB removing with forceps under the guidance of fluoroscopic carotid artery guidewire-positioning. DSA was used to evaluate the effect of interventional therapy. Furthermore, CTA or MRA was used for following-up. Results The technical successful rate of direct trans-sheath stent implantation in experiment group was 100%(5/5), but the rate of aneurysm bleeding after interventional FB retrieval was also 100%(5/5). All hemorrhage symptoms were cured after degradable covered-stents releasing. No aneurysm recurrence occurred 3 months after intervention, but mild to moderate stenosis of local carotid were found in all models in experiment group. In control group, the successful rate of FB retrieval was 100%(5/5) without carotid hemorrhage or stenosis. Conclusion As an one-stop method, degradable covered-stent-assisted dual intervention can be used to remove FB and occlude traumatic carotid aneurysm of neck in dog models simultaneously. Direct trans-sheath implantation may be an alternative method for stent placement in animal study.