摘要
目的 探讨应用甲基丙烯酸甲酯和甲基丙烯酸-2-羟基乙酯合成共聚物栓塞脑动静脉畸形（AVM）的可行性。方法 将共聚物溶液加入碘海醇，栓塞体外AVM模型和7头家猪颅底微血管网（RMB）。操作完毕后检查微导管，观察微导管内壁。通过血管造影复查共聚物对家猪RMB的栓塞稳定性。组织学检查探讨共聚物的组织相容性和栓塞稳定性。结果 应用共聚物溶液共栓塞了9个体外AVM模型，共聚物在玻璃珠之间弥散均匀，能有效终止通过的水流。微导管内壁无共聚物黏附。应用共聚物对7头家猪的9个RMB进行栓塞，均取得了满意栓塞。除了最初1头由于栓塞时注入共聚物溶液过快发生动物死亡外，其余6头动物均存活良好。共复查造影4头，均未发现栓塞后血管再通。共聚物在血管内可弥散到直径为80～150μm的血管腔内。栓塞后2日血管腔内可见中性粒细胞聚集，提示有轻度炎性反应。栓塞后2周的标本除了血管腔内及其周围有轻度炎症变化外，未见血管壁破坏和形态学改变。栓塞后2个月和6个月的组织标本可见结缔组织增生和轻中度慢性炎症反应，RMB血管壁及其周围组织可见异物巨细胞反应。结论 作为一种非黏附性的液体栓塞材料，该共聚物黏度低，容易通过输送微导管，生物相容性好，栓塞效果稳定，可用于脑AVM的栓塞治疗。
Objective To investigate the feasibility of using methyl methacrylate （MMA） and 2- hydroxyethyl methacrylate （HEMA） to embolize cerebral arteriovenous malformations （ AVM ）. Methods Methyl methacrylate （MMA） and 2-hydroxyethyl methacrylate （HEMA） in the ratio of 9：1 were solved in 16% alcohol so as to make a kind of copolymer （CoHEMA）. 12 g glass beads 2 mm in diameter were put into a container so as to construct an in vitro model of AVM. The container was connected with a normal saline bottler via microcatheter. CoHEMA, as embolizer, was injected through the microcatheter and the diffusion of CoHEMA was observed till the water flow was stopped. CoHEMA was injected through microcatheter into the pharyngeal ascending arteries near the rete mirabile （RMB） tissue, similar to the human AVM, under digital subtraction angiography until satisfactory embolization was obtained, totally 9 RMB tissues in 7 pigs. Five pigs were injected with normal saline as controls. The pigs were killed 2 days, 2 weeks, and 6 months after embolization respectively and the bilateral RMB tissues were taken out to undergo pathological examination. Results Nine AVM models in vitro were constructed with the copolymer dispersed symmetrically among the glass beads and stopped the fluid across the model effectively. No copolymer adhered to the wall of microcatheter. Nine RMB tissues of 6 pigs were embolized by using CoHEMA. Six of the seven pigs survived the procedure except one died of too fast injection of copolymer in the primary stage. Follow-up angiography was performed in four pigs and found that no recanalization occurred and the copolymer was diffused in the vessels 80 - 150 μm in diameter. In the specimens obtained 2 days after embolization, neutrophilic granulocytes scattered surrounding the copolymer, suggesting minor inflammatory reaction. In the specimens obtained 2 weeks after embolization no vessel wall damage and morphological change were found except minor inflammatory reaction inside the vessels and surrounding tissues. In the specimens obtained 2 to 6 months after embolization hyperplasia of connective tissue, minor or mediate chronic inflammatory reaction, and giant cell reaction inside the vessels and surrounding tissues. Conclusion With low viscosity, better biocompatibility, and embolic instability, and easy to be injected through delivery microcatheter, CoHEMA is an excellent non-adhesive embolic material and can be used in embolic treatment of cerebral AVM.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第3期152-156,共5页
National Medical Journal of China
关键词
甲基丙烯酸甲酯类
动静脉畸形
栓塞
Methylmethacrylates
Arteriovenous malformations
Embolism
