Cellular Mechanisms of Aneurysm Occlusion after Treatment with a Flow Diverter
Cellular Mechanisms of Aneurysm Occlusion after Treatment with a Flow Diverter
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DOI：
10.1148/radiol.13130796
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发表时间：
2014-02-01
期刊：
影响因子：
19.7
通讯作者：
Kallmes, David F.
中科院分区：
文献类型：
--
作者：
Kadirvel, Ramanathan;Ding, Yong-Hong;Kallmes, David F.
目的：研究兔动脉瘤模型中应用分流装置治疗后动脉瘤颈部愈合的进展情况。材料和方法：在机构动物护理和使用委员会批准的情况下，20只兔制作囊状动脉瘤并使用分流装置进行治疗。分别于植入后第1、3、7天、4、8周取材，取动脉瘤及植入支架的血管。大体标本进行内皮细胞、内皮祖细胞、平滑肌细胞和炎性细胞的EN染色。结果：在第1天和第3天，血流分流器覆盖的载瘤动脉段完全没有内皮细胞，但在第7天已经完全内皮化。在所有时间点，沿着动脉瘤颈部开放部分的支柱都有零星的组织岛，完全由炎症细胞组成。在4周和8周时，所有沿着载瘤动脉与组织相邻的样本都在动脉瘤颈的闭塞节段出现半透明组织。绝大多数内皮细胞与载瘤动脉毗邻，其下方有平滑肌细胞。在任何动脉瘤的颈部均未发现内皮祖细胞。只有当支架上出现完全或接近完全的内皮化时，才能注意到动脉瘤闭合。结论：分流治疗后的最初事件是炎性细胞群跨越动脉瘤颈部的粘连。血管内皮化相对延迟，且完全来源于邻近载瘤动脉内的细胞。
Purpose: To characterize the progression of healing across aneurysm necks following treatment with a flow diverter in a rabbit aneurysm model.Materials and Methods: With institutional animal care and use committee approval, saccular aneurysms were created in 20 rabbits and treated with flow diverters. On days 1, 3, and 7 and weeks 4 and 8 after implantation, the aneurysm and the device-implanted vessel were harvested. En face staining of the gross specimen was performed for endothelial cells, endothelial progenitor cells, smooth muscle cells, and inflammatory cells.Results: The parent artery segments covered by the flow diverters were completely devoid of endothelial cells at 1 and 3 days but had completely reendothelialized by 7 days. At all time points, the struts along the patent portions of the aneurysm necks harbored scattered tissue islands composed exclusively of inflammatory cells. At 4 and 8 weeks, all samples contiguous with the tissue along the parent arteries had translucent tissue present along the occluded segments of the aneurysm neck. The vast majority of endothelial cells were contiguous with the parent artery and had smooth muscle cells underlying them. Endothelial progenitor cells were not observed along the neck of any aneurysm. Aneurysm closure was noted only when complete or nearly complete endothelialization over the device struts was present.Conclusion: The initial event following flow diversion treatment is adherence of clusters of inflammatory cells across the aneurysm neck. Endothelialization is relatively delayed and derived exclusively from cells in the adjacent parent artery.