【作者】 刘作勤； 盛希忠； 武乐斌； 唐军； 赵成如； 孔令斌； 王芹；

【Author】 UU Zuo-qing, SHENG Xi-zhong, WU Le-bin ,et al. Shandong University Medical College, Jinan 250012, China

【机构】 山东省医学影像学研究所； 山东大学医学院； 山东省医疗器械研究所；

【摘要】 目的:应用氮-异丙基丙烯酰胺(NIPAM)和氮-正丙基丙烯酰胺(NNPAM)共聚物水溶胶栓塞猪的奇网(RMB),探讨其栓塞脑动静脉畸形的可行性。方法:应用共聚物水溶胶加入碘海醇作为对比剂,栓塞30头猪的RMB,复查血管造影随访栓塞效果。栓塞完毕后,观察微导管的变化。RMB进行组织学检查,观察栓塞血管及其周围改变。结果:应用共聚物水溶胶对30头家猪的30个RBM进行栓塞,栓塞后28例动物存活良好,2例死亡,1例死于大脑半球栓塞,另1例死于栓塞剂逆流。栓塞后微导管内壁光滑,未见共聚物粘附在微导管内壁。复查造影20例,18例未出现。RMB血管再通,另2例由于栓塞咽升动脉主干,出现部分RMB再通。组织学检查,水溶胶在血管内可弥散到直径为100-200μm的血管腔内,栓塞侧RMB血管无内膜损害和血管壁坏死,血管周围未见急性炎性反应,可见结缔组织增生和轻中度慢性炎症反应,RMB血管壁及其周围元异物巨细胞反应。结论:作为温度敏感性栓塞材料,该共聚物水溶胶对AVM模型栓塞稳定,生物相容性好,不透X线,不粘管,与普通微导管相兼容,可视为脑AVM血管内治疗的一种新型液体栓塞材料。更多还原

【Abstract】 Objective:To embolize swine rete mirabiles(RMB) with the copolymer of N-isopropylacrylamide (NIPAM) and N-n-propylacrylamide (NNPAM) and investigate it’s embolic feasibility of as an embolic agent in cerebral arteriovenous malformations. Methods: The copolymer was mixed with and was embolized in 30 swine RMB. Repeated angiography was performed for embolic efficacy follow-up after embolization. Embolized RMB were examined histopatholgically and alterations were observed in side RMB and surrounding tissue. Results:The copolymer hydrogel was embolized in 30 swine RMBs, 28 swine survived the embolization, 2 swine died, one swine died of cerebrum and another died of embolic agent countercurrent. The microcatheter inside was smooth and there was no copolymer adhered to the wall. Repeated angiography was performed in 20 swine, there were no RMB recanalization in 18 swine and partial RMB recanalization in 2 swine because of the trunk embolization of ascending pharyngeal arteries. Histopatholgically, the hydrogel was found diffused in vessels Of 100 - 200μm in diameter. There was no endothelium damage, necrosis and a- cute inflammatory reaction inside the RMB and surrounding tissue in acute swine. In chronic swine , it was found that there was connective tissue growth and a moderate inflammatory reaction inside the RMB and surrounding tissue, without a foreign body reaction. Conclusion: As a thermosensitive embolic material, the copolymer hydrogel has optimized characteristics including embolic instability , better biocompatibility, radiopacity, non - adhesiveness, compatible to general microcatheters, it could be regarded as a new liquid embolic material in endovascular treatment of cerebral AVMs.更多还原