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目的应用氮异丙基丙烯酰胺和氮正丙基丙烯酰胺及乙烯基己内酰胺三元共聚物水凝胶栓塞猪的颅底微血管网(RMB),探讨其栓塞脑动静脉畸形(AVM)的可行性。方法应用共聚物水凝胶加入碘海醇,栓塞6头猪的RMB,复查血管造影随访栓塞效果。栓塞完毕后,观察微导管的变化。RMB进行组织学检查,观察栓塞血管及其周围改变。结果应用共聚物水凝胶对6头家猪的10个RMB进行栓塞,栓塞后动物存活良好。栓塞后微导管内壁光滑,未见共聚物粘附在微导管内壁。复查造影4例,3例未出现RMB血管再通,另1例由于栓塞咽升动脉主干,出现部分RMB再通。组织学检查可见水凝胶可弥散到直径为80～150μm的血管腔内。急性期标本微血管腔内共聚物周围可见中性粒细胞,内膜完整,无剥脱和坏死。亚急性期和慢性期组织标本微血管腔内仍可见共聚物存在,共聚物内及其周围可见散在的单核细胞和嗜酸性粒细胞。肌层松散,大部分细胞核降解,呈缺血样改变。结论该共聚物水溶胶对AVM模型栓塞稳定,生物相容性好,不透X线,不粘管,与普通微导管相兼容,可作为脑AVM血管内治疗的一种新型液体栓塞材料。
Objective To investigate the feasibility of embolization of cerebral arteriovenous malformation (AVM) by embolizing the skull base capillary network (RMB) with N-isopropylacrylamide, N-propylacrylamide and vinyl caprolactam terpolymer hydrogel. . Methods The copolymer hydrogel was added iohexol to embolize RMB of 6 pigs. The embolization effect of angiography was retrospectively reviewed. After the embolization is completed, the changes of the microcatheter are observed. RMB for histological examination to observe the changes of embolized blood vessels and their surroundings. Results 10 RMB of 6 domestic pigs were embolized with copolymer hydrogel, and the animals survived well after embolization. After embolization, the inner wall of the microcatheter is smooth, and no copolymer adheres to the inner wall of the microcatheter. Review of 4 cases of angiography, 3 cases did not appear RMB vascular recanalization, and the other as a result of thrombosis pharyngeal ascending artery trunk, some RMB recanalization. Histological examination showed that the hydrogel can diffuse into the vascular lumen with the diameter of 80 ~ 150μm. Acute phase specimens of microvascular lumen within the copolymer visible neutrophils, endometrial integrity, no exfoliation and necrosis. Sub-acute and chronic tissue samples can still be seen within the microvascular cavity copolymer exists, within and around the copolymer scattered mononuclear cells and eosinophils. Muscle loose, most of the nucleus degradation, showed ischemic changes. CONCLUSION: The copolymer hydrogel has stable embolism, good biocompatibility, radiopacity, non-sticking, and compatible with common microcatheter. It can be used as a new liquid embolic material for endovascular treatment of AVM.