Local metabolism in severe brain injury and hypothermia. [Investigation of Endothelial Cell Proliferation on the Coil Surface after Endovascular Treatment Using Factor XIII : Preliminary Results in Swine Model]

针对目前能应用亚低温治疗的重型颅脑损伤病例较少的情况，我们进行了脑动脉瘤破裂蛛网膜下腔出血致重型颅脑损伤的实验研究。在因脑动脉瘤破裂而导致严重脑损伤的患者中，目前经常使用可脱性弹簧圈进行血管内治疗，然而，这种方法还不能被称为已确立的治疗方法，因为该方法仅在几年前引入，并且弹簧圈栓塞动脉瘤的治愈机制尚未阐明。方法和结果：在7只成年猪中制作了14个动脉瘤，并用Guglielmi可解脱弹簧圈（GDC）栓塞。在弹簧圈栓塞后立即或3周切除动脉瘤，并进行组织学和扫描电镜检查。在栓塞当天和栓塞后4天，对4只动物给予凝血因子XIII。这些动脉瘤也在栓塞后3周切除，并进行组织学研究。显着的成纤维细胞增殖和血管内皮细胞的生长的线圈的管腔内表面上观察到更经常在组中给予因子XIII比那些没有给予因子XIII。这些结果表明，因子XIII的管理可能有助于更有效的动脉瘤闭塞在线圈栓塞。

Because of few cases of severe brain injury which could be treated by hypothermia, we performed an experimental research of treatment of severe brain injury caused by subarachnoid hemorrhage due to ruptured cerebral aneurysm. In patients with severe brain injury due to ruptured cerebral aneurysm, intravascular treatment using detachable coils are now being often used and however, this method can not yet be called as an established treatment because the method have been introduced only a few years before and the mechanism of cure of coiled aneurysms have not been clarified. The method and results : Fourteen aneurysms were produced in seven matured swine and embolized with Guglielmi Detachable coils (GDCs). The aneurysms were resected either immediately or 3 weeks after coil embolization, and subjected to histological and scanning electron microscopic examinations. Blood coagulation factor XIII was administrated in 4 animals on the day of embolization and following 4 days. These aneurysms were also resected 3 weeks after the embolization and investigated histologically. Marked fibroblast proliferation and growth of endothelial cells on the intraluminal surface of the coil were observed more often in the group administrated factor XIII than in those not given factor XIII.These results suggest that administration of factor XIII may contribute to more effective aneurysm obliteration during coil embolization.