Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Mechanical Recanalization of Cerebral Artery Embolic Occlusion Using a Self-Expanding Stent: Experimental Analysis in Canine Model

자가 팽창성 스텐트를 사용한 색전성 뇌혈관 폐쇄의 기계적 재개통: 잡견 모델에서의 실험적 평가

  • Choi, Jin-Woo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Sang-Joon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Deok-Hee (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Suh, Dae-Chul (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 최진우 (울산대학교 의과대학 서울아산병원 영상의학과학교실) ;
  • 김상준 (울산대학교 의과대학 서울아산병원 영상의학과학교실) ;
  • 이덕희 (울산대학교 의과대학 서울아산병원 영상의학과학교실) ;
  • 서대철 (울산대학교 의과대학 서울아산병원 영상의학과학교실)
  • Published : 2011.07.01
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Abstract

Purpose: To evaluate the feasibility of a self-expanding stent for acute embolic occlusion, and recanalization mechanism by histologic examination. Materials and Methods: Five mongrel dogs were used as study subjects. Each vertebral artery was occluded, and a self-expanding stent was used for recanalization. We evaluated the technical success rate for the placement of the stent to the targeted vessel, the recanalization rate, and residual stenosis. We obtained two specimens of the stented vertebral arteries for histologic evaluation. Results: One dog died of an unknown cause during the induction of anesthesia. In two dogs, only one side of the vertebral artery was used, whereas both vertebral arteries were used in the remaining dogs. A total of six vertebral arteries were successfully occluded. The technical success rate for stenting without complication was 66.7%. The immediate recanalization rate after stenting was 100%. The residual stenosis was 35.6 ${\pm}$ 18.6%. On microscopic examination, the stent concentrically displaced the clot and the clot was captured between the stent mesh and arterial wall. Conclusion: Self-expanding stents were effective in revascularizing the cerebrovascular embolic occlusion. The self-expanding stent seemed to achieve recanalization by pushing the clot to the arterial wall and capturing the clot between the stent mesh and arterial wall.

목적: 자가 팽창성 스텐트가 효과적으로 뇌동맥 폐쇄를 재개통시킬 수 있는가와 조직학적 관찰을 통하여 재개통의 기전을 알아보고자 하였다. 대상과 방법: 다섯 마리의 잡견에서 색전성 척추 동맥 폐쇄 모델을 만든 후, 폐쇄된 동맥에 스텐트를 삽입하였다. 스텐트 설치의 기술적인 성공 여부를 분석하였으며 스텐트 삽입 후 폐쇄된 부위의 재관류 여부를 분석하고 남아 있는 협착의 정도를 계산하였다. 두 마리의 잡견에 대하여 부검을 시행하였다. 결과: 한 마리의 잡견은 마취 도중 사망하였다. 두 마리 한개의 척추 동맥을, 나머지 두 마리는 양측의 척추 동맥에 대하여 차례로 폐쇄를 시행하여 6개의 척추 동맥을 폐쇄하였다. 스텐트 설치시 1예에서 혈전을 미세 유도카테터가 지나갈 때 혈전의 부서짐과 원위부 전위가 관찰되었고, 한 예에서 스텐트가 원위로 이동하여 혈전의 근위부를 스텐트가 완전하게 덮지 못하여 기술적인 성공은 66.7%였으며 모든 예에서 100%의 재개통률을 보였다. 남아 있는 협착은 35.6 ${\pm}$ 18.6%였다. 조직학적으로 혈전의 중앙에 스텐트가 있었으며 혈전은 스트럿과 혈관 벽 사이에 끼어 있었다. 결론: 인공적으로 유발된 척추 동맥 폐쇄에서 자가 팽창성 스텐트의 삽입은 높은 재관류율을 나타내었다. 혈전에 스텐트를 삽입하였을 때 스텐트는 혈전을 혈관 벽으로 밀어서 혈류를 재개통시키는 것으로 생각한다.

Keywords

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