光学相干断层扫描成像在动物模型血流导向装置贴壁评估中的应用  

Application of optical coherence tomography to assess flow diverter apposition in animal models

作　　者：李腾飞[1] 史帅龙 龙树海 苗仁英 段旭华[1] 朱泽飞 马骥[1] Li Tengfei;Shi Shuailong;Long Shuhai;Miao Renying;Duan Xuhua;Zhu Zefei;Ma Ji(Department of Interventional Radiology,the First Afiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Vascular Surgery,the First Afiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科,郑州450052 [2]郑州大学第一附属医院血管外科,郑州450052

出　　处：《中华神经外科杂志》2024年第11期1148-1153,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81801806);河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029);河南省高等学校重点科研项目(24A320038);河南省科技攻关项目(242102310109)。

摘　　要：目的探讨光学相干断层扫描成像(OCT)在巴马小型猪颈总动脉(CCA)和颌内动脉(IMA)血流导向装置(FD)置入模型支架贴壁情况评估中的应用价值。方法选择月龄为3~4个月的健康巴马小型猪(以下简称实验猪)12头, 其中8头于CCA、4头于IMA内置入Tubridge FD, 每头实验猪置入1枚FD。支架置入术后即刻行OCT和高分辨C型臂CT扫描, 评估FD贴壁情况。术后12周末行数字减影血管造影(DSA), 评估支架内血流通畅情况;行OCT检查, 观察支架内血管内皮化程度;取FD置入区域的CCA和IMA组织, 应用数字病理切片扫描仪行组织病理学检查;分析FD置入即刻显示的支架贴壁不良(ISA)程度对术后12周支架内皮化进程的影响。结果 12枚FD均成功置入, 其中8枚置入CCA, 4枚置入IMA。FD置入即刻OCT显示12枚FD均存在血管远心端或局部不同程度的ISA, 共21处;而高分辨C型臂CT扫描显示, 置入IMA的2枚FD远心端存在ISA, 共2处, 其余FD均贴壁良好。术后12周DSA显示, 1枚FD发生管腔闭塞;11枚FD管腔血流通畅, 未见明显狭窄;OCT显示除外1枚支架内闭塞, 11枚FD中, 4枚支架内皮化不良(存在8处ISA), 7枚支架内皮化良好;组织病理学检查显示, 1枚闭塞的FD管腔内机化血栓形成, 4枚FD表现为支架远心端或局部编织丝表面无明显内膜覆盖, 7枚FD支架内膜增生良好。FD置入12周, 4枚支架内皮化不良组其术后即刻ISA处支架编织丝与血管内壁的距离为(612.80±15.75)μm, 7枚支架内皮化良好组的距离为(495.57±64.03)μm , 差异有统计学意义(P=0.003)。术后即刻OCT检出的18处(未包括发生支架闭塞的3处)ISA中, 支架编织丝与血管内壁距离>600 μm组8处, 400~600 μm组10处, FD置入12周两组分别有7、1处支架内皮化不良, 1、9处支架内皮化良好, 两组内皮化程度差异有统计学意义(P=0.003)。结论 OCT可以精确评估FD血管内贴壁情况和内皮化进程, 与组织病理学检查结果吻合度Objective To investigate the clinical utility of optical coherence tomography(OCT)in the assessment of stent apposition following flow diverter(FD)implantation models in the common carotid artery(CCA)and internal maxillary artery(IMA)of Bama mini-piglets.Methods Tubridge FDs were implanted in the CCA(8 pigs)and IMA(4 pigs)of 12 Bama mini-piglets aged 3~4 months,with one Tubridge FD in each experimental pig.OCT and high-resolution C-arm CT were conducted immediately following stent implantation to assess the FD apposition.Digital subtraction angiography(DSA)was performed 12 weeks post procedure to assess the stent patency.Concurrently,OCT was utilized to examine the degree of endothelialization.Histopathological analysis was carried out on the CCA and IMA at the site of FD implantation.In addition,the effect of incomplete stent apposition(ISA)on stent endothelialization was analyzed.Results A total of 12 FDs were implanted,with 8 placed in the CCA and 4 in the IMA.Immediately following FD implantation,OCT revealed 21 ISAs at the distal or local in 12 FDs.However,high-resolution C-arm CT indicated that 2 ISAs were present distally in only 2 FDs implanted in the IMA,while the other FDs exhibited complete apposition.At 12 weeks post procedure,DSA demonstrated lumen occlusion in 1 FD,whereas no significant stenosis was observed in the remaining 11 FDs.OCT finding indicated that aside from 1 stent occlusion,4 out of 11 FDs displayed poor stent endothelialization characterized by 8 ISAs;conversely,7 exhibited good stent endothelialization.Histopathology revealed that the single occluded FD presented with intracavitary thrombus.In 4 FDs,there was no apparent intimal coverage at the distal or local braided wire.Excellent intimal hyperplasia was identified in 7 FDs.At 12 weeks post FD implantation,measurements showed that the distance between the stent braid wire and inner vessel wall at ISAs averaged 612.80±15.75μm for 4 poorly endothelialized stents and 495.57±64.03μm for 7 well endothelialized stents,and the differe

关 键 词：体层摄影术 光学相干 血流导向装置 支架贴壁 猪 雏型 

分 类 号：R816.2[医药卫生—放射医学]