Evaluation of a second-generation self-expanding variable-porosity flow diverter in a rabbit elastase aneurysm model.
Evaluation of a second-generation self-expanding variable-porosity flow diverter in a rabbit elastase aneurysm model.
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DOI：
10.3174/ajnr.a2548
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发表时间：
2011-09
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影响因子：
--
通讯作者：
Rudin S
中科院分区：
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作者：
Ionita CN;Natarajan SK;Wang W;Hopkins LN;Levy EI;Siddiqui AH;Bednarek DR;Rudin S
自膨式V-POD是第二代血流导向装置，自膨式微型支架上带有低孔隙率PTFE补片。作者评价了该器械用于治疗兔弹性蛋白酶诱导的动脉瘤。通过血管造影术、锥形束显微CT、组织学和SEM评价了三种V-POD类型（A，环形补片闭孔支架[n = 9]; B，不对称补片闭孔支架[n = 7];和C，不对称补片开孔支架[n = 4]）。动脉瘤血流改变以手术血管造影片上跟踪的进入动脉瘤圆顶的最大CA体积的即刻支架植入后/当前比率表示。血流改变与4周随访血管造影、显微CT、组织学和SEM结果相关。4例动脉瘤（1例A型; 3例B型）的机械支架展开困难导致结果不佳，并从分析中排除。在其余16个动脉瘤中，治疗后4周的血管造影显示10个（63%）动脉瘤无充盈，3个（~19%）动脉瘤无充盈伴少量残余瘤颈，3个（~19%）动脉瘤充盈<0.25。成功治疗的动脉瘤（n = 16）显示支架植入后即刻/支架植入前CA最大体积比为0.13 ± 0.18%（0.0%-0.5%）。展开后立即血管造影的有利对比剂流修改与随访血管造影、微型CT和组织学的动脉瘤闭塞显着相关。micro-CT显示的闭塞率为96 ± 6.8%。组织学检查表明，16例病例中有13例动脉瘤瘤顶愈合（≥3级）。SEM显示16枚支架中有15枚处于内皮化晚期状态。本研究显示了V-POD在兔弹性蛋白酶模型中用于动脉瘤愈合的可行性和有效性。
The self-expanding V-POD is a second-generation flow-diverting device with a low-porosity PTFE patch on a self-expanding microstent. The authors evaluated this device for the treatment of elastase-induced aneurysms in rabbits. Three V-POD types (A, circumferential patch closed-cell stent [n = 9]; B, asymmetric patch closed-cell stent [n = 7]; and C, asymmetric patch open-cell stent [n = 4]) were evaluated by using angiography, conebeam micro-CT, histology, and SEM. Aneurysm flow modifications were expressed in terms of immediate poststent/prestent ratios of maximum CA volume entering the aneurysm dome tracked on procedural angiograms. Flow modifications were correlated with 4 weeks’ follow-up angiographic, micro-CT, histologic, and SEM results. Mechanical stent-deployment difficulties in 4 aneurysms (1 type A; 3 type B) led to suboptimal results and exclusion from analysis. Of the remaining 16 aneurysms, 4-week posttreatment angiograms showed no aneurysm filling in 10 (63%), 3 (~19%) had no filling with a small remnant neck, and 3 (~19%) had <0.25 filling. Successfully treated aneurysms (n = 16) demonstrated an immediate poststent/prestent CA maximum volume ratio of 0.13 ± 0.18% (0.0%–0.5%). Favorable contrast-flow modification on immediate angiography after deployment correlated significantly with aneurysm occlusion on follow-up angiography, micro-CT, and histology. The occlusion percentage derived from micro-CT was 96 ± 6.8%. Histology indicated advanced healing (grade ≥3) in the aneurysm dome in 13 of 16 cases. SEM revealed 15 of 16 stents in an advanced state of endothelialization. This study showed the feasibility and effectiveness of V-POD for aneurysm healing in a rabbit elastase model.