Aneurismas saculares: avaliação experimental de procedimento terapeutico por via intravascular

Siqueira, Mario G.; Vieira, Ivoney A.; Cilião, Elizeu A.; Guerra, Dora M. G.

doi:10.1590/S0004-282X1980000100004

Resumos

Visando à avaliar a possibilidade de ocluir aneurismas saculares através da injeção intra-vascular por cateterismo super-seletivo de um adesivo tecidual, os autores injetaram Bucrylat (isobutil-2-cianoacrilato) no interior de quatorze aneurismas produzidos artificialmente em artérias carótidas de cães. Estudos angiográficos realizados imediatamente antes e depois da injeção e 1 mês após o tratamento revelaram uma oclusão progressiva e persistente dos aneurismas. Os exemplares examinados histologicamente 1 mês após a injeção demonstraram a presença de uma faixa fibrosa endotelializada cruzando o colo do aneurisma, o que parece indicar o caráter permanente da oclusão dos aneurismas tratados. Em nosso estudo, a reação tecidual ao adesivo foi discreta e restrita à íntima das artérias. A aplicação clínica deste método dependerá dos avanços nas técnicas de cateterização intracraniana super-seletiva, que irão permitir um cateterismo preciso e seguro da câmara aneurismática.

Studies were performed on adult mongrel dogs to evaluate the possibility of occluding saccular aneurysms with an intravascular injection of the tissue adhesive Bucrylat (isobutyl-2-cyanoacrylate). Fourteen surgically constructed carotid aneurysms were occluded by the injection of Bucrylat through a fluoroscopically positioned intra-arterial catheter. Angiography performed immediately before and after injection and up to 1 month following treatment revealed progressive and persistent occlusion of the aneurysms. The specimens examined histologically 1 month after the injection showed an endothelialized fibrous tissue bridge crossing the neck of the aneurysm what appear to indicate a permanent occlusion of the structures treated. A similar approach to treat intracranial aneurysms will depend on advances in the field of selective intracranial catheterization that will permit safe and accurate catheterization of the aneurysm sac.

Aneurismas saculares: avaliação experimental de procedimento terapeutico por via intravascular

Saccular aneurysms: experimental evaluation of the efficacy of an intra-vascular therapeutic procedure

Mario G. Siqueira^I; Ivoney A. Vieira^II; Elizeu A. Cilião^II; Dora M. G. Guerra^III

^IChefe do Serviço de Neurocirurgia do Hospital Evangélico de Londrina

^IIDoutorandos da Escola de Medicina Veterinária da Fundação Universidade Estadual de Londrina

^IIIProfessora Assistente de Anatomia Patológica da Faculdade de Medicina da Fundação Universidade Estadual de Londrina

RESUMO

Visando à avaliar a possibilidade de ocluir aneurismas saculares através da injeção intra-vascular por cateterismo super-seletivo de um adesivo tecidual, os autores injetaram Bucrylat (isobutil-2-cianoacrilato) no interior de quatorze aneurismas produzidos artificialmente em artérias carótidas de cães. Estudos angiográficos realizados imediatamente antes e depois da injeção e 1 mês após o tratamento revelaram uma oclusão progressiva e persistente dos aneurismas. Os exemplares examinados histologicamente 1 mês após a injeção demonstraram a presença de uma faixa fibrosa endotelializada cruzando o colo do aneurisma, o que parece indicar o caráter permanente da oclusão dos aneurismas tratados. Em nosso estudo, a reação tecidual ao adesivo foi discreta e restrita à íntima das artérias. A aplicação clínica deste método dependerá dos avanços nas técnicas de cateterização intracraniana super-seletiva, que irão permitir um cateterismo preciso e seguro da câmara aneurismática.

SUMMARY

Studies were performed on adult mongrel dogs to evaluate the possibility of occluding saccular aneurysms with an intravascular injection of the tissue adhesive Bucrylat (isobutyl-2-cyanoacrylate). Fourteen surgically constructed carotid aneurysms were occluded by the injection of Bucrylat through a fluoroscopically positioned intra-arterial catheter. Angiography performed immediately before and after injection and up to 1 month following treatment revealed progressive and persistent occlusion of the aneurysms. The specimens examined histologically 1 month after the injection showed an endothelialized fibrous tissue bridge crossing the neck of the aneurysm what appear to indicate a permanent occlusion of the structures treated. A similar approach to treat intracranial aneurysms will depend on advances in the field of selective intracranial catheterization that will permit safe and accurate catheterization of the aneurysm sac.

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Full text available only in PDF format.

Nota dos autores - Nossos agradecimentos à Ethicon Suturas S.A, e aos Laboratórios Ayerst Ltda. pela colaboração prestada.

Rua Cambará 562 - 86.100 Londrina, PR - Brasil

Errata

No trabalho "Aneurismas saculares: avaliação experimental de procedimento terapêutico por via intravascular", de autoria do Dr. Mário G. Siqueira e col., publicado no exemplar de Março-1980 desta revista (págs. 24 a 32) ocorreu um deslise editorial de gravidade pois foi incluído, no título principal, o qualificativo intracranianos quando, na verdade, se tratava de aneurismas saculares produzidos experimentalmente na bifurcação da artéria carótida comum de cães adultos. Felizmente este deslise editorial nâo ocorreu no título do trabalho em inglês, não sendo prejudicado, portanto, o indexamento internacional do trabalho.

Assumindo a inteira responsabilidade pelo ocorrido, o Editor da revista pede escusas aos autores.

1. ALKSNE, J. F. & SMITH, R. W. - Iron-acrylic compound for stereotaxic aneurysms thrombosis. J. Neurosurg. 47:137, 1977.
2. BANK, W. O.; KERBER, C. W.; DRAYER, B. P.; TROOST, B. T. & MAROON, J. C. - Fistule carotido-caverneuse: occlusion endo-artérielle par cyanoacrylate avec conservation du flux carotidien. J. Neuroradiol. (Paris) 5:279, 1978.
3. CHOU, S. N.; ORTIZ-SUAREZ, H. J. & BROWN Jr., W. E. - Technique and material for coating aneurysms. Clin. Neurosurg. 21:182, 1974.
4. DAVIS, D. O. & RUMBAUGH, C. L. - Cerebral angiography in the dog: method for consistent results. Invest. Radiol. 2:323, 1967.
5. De La TORRE, E.; NETSK, M. G. & MESCHAM, I. - Intracranial and extracranial circulation in the dog: anatomic and angiographic studies. Am. J. Anat. 105:343, 1959.
6. DUTTON, J. & YATES, P. O. - An experimental study of the effects of a plastic adhesive, methyl- 2-cyanoacrylate monomer (M2C-1) in various tissues. J. Neurosurg. 24:876, 1966.
⁷
Ethicon Bucrylat: Klebstoff für menschlicres gewebe. In Ethicon Fortschrifte für die Chirurgie. Ethicon GmbH. 2 Hamburg-Norderstedt, 1972.
8. GENEST, A. S. - Experimental use of intraluminal plastic in the treatment of carotid aneurysms: preliminary report. J. Neurosurg. 22:136, 1965.
9. HILAL, S. K. & MICHELSEN, J. W. - Therapeutic percutaneous embolization for extra-axial vascular lesions of the head, neck and spine. J. Neurosurg. 43:275, 1975.
10. MANAKA, S.; IZAWA, M. & NAWATA, H. - Dural arteriovenous malformation treated by artificial embolization with liquid silicone. Surg. Neurol. 7:63, 1977.
11. MARGOLIS, M. T.; FREENY, P. C. & KENDRICK, M. M. - Cyanoacrylate occlusion of a spinal cord arteriovenous malformation. Case report. J. Neurosurg. 51:107, 1979.
12. MAZUR, J. B. & SALAZAR, J. L. - Late thrombosis of middle cerebral artery following clipping and coating of aneurysms. Surg. Neurol. 10:131, 1978.
13. Method of focal spot image and mesurements. Report of the International Comission on Radiological Units and Measurements. Am. J. Roentgen. 85:191, 1961.
14. SANO, K.; JIMBO, M.; SAITO, I. & BASUGI, N. - Artificial embolization of inoperable angioma with polymerizing substante. In H. W. Pia, J. R. W. Gleave, E. Grote e J. Zierski, ed. - Cerebral Angiomas. Springer-Verlag, Berlin, 1975, P. 221.
15. SANO, K.; JIMBO, M.; SAITO, I.; TERAO, H. & HIRAKAWA, K. - Artificial embolization with liquid plastic. Neurol. Med.-Chir. (Tokyo) 8:198, 1966.
16. SELVERSTONE, B. - Coating of intracranial aneurysms with nontoxic adherent plastics. In H. H. Schmidek e W. H. Sweet, ed. - Current Techniques in Operative Neurosurgery. Grune & Stratton, New York, 1977, p. 31.
17. SIQUEIRA, M. G.; ROJAS, R. A. G. & STURION. D. J. - Aneurismas experimentais: Proposição de nova técnica. Arq. Neuro-Psiquiat. (São Paulo) 38:18, 1980.
18. SMITH, R. "W. & ALKSNE, J. F. - Stereotaxic thrombosis of inacessible intra-cranial aneurysms. J. Neurosurg. 47:833, 1977.
19. TROUPP, H. & RINNE, T. - Methyl 2-cyanoacrylate (Eastman 910) in experimental vascular surgery. With a note on experimental arterial aneurysms. J. Neurosurg. 21:1067, 1964.
20. TSUCHIYA, G.; SUGAR, O.; YASHON, D. & HUBBARD, J. - Reactions of rabbit brain and peripheral vessels to plastics used in coating arterial aneurysms. J. Neurosurg. 28:409, 1968.
21. VANDER ARK, G. D.; PITKETHLY, D. T.; DUCKER, T. B. & KEMPE, L. G. Repair of cerebrospinal fluid fistulas using a tissue adhesive. J. Neurosurg. 33:151, 1970.
22. YASHON, D.; JANE, J. A.; GORDON, M. C; HUBBARD. J. L. & SUGAR, O. -Effects of methyl 2-cyanoacrylate adhesives on the somatic vessels and the central nervous system of animals. J. Neurosurg. 24:883, 1966.
23. YODH, S. B. & WRIGHT, R. L. - Experimental evaluation of four synthetic adhesives for possible treatment of aneurysms. J. Neurosurg. 26:504, 1967.
24. YODH, S. B. & WRIGHT, R. L. - Experimental evaluation of synthetic adhesives by intra-arterial injection. Neurochirurgia (Stuttgart) 13:118, 1970.
25. ZANETTI, P. H. & SHERMAN, F. E. - Experimental evaluation of a tissue adhesive as an agent for the treatment of aneurysms and arteriovenous anomalies. J. Neurosurg. 36:72, 1972.

Datas de Publicação

Publicação nesta coleção
22 Ago 2012
Data do Fascículo
Mar 1980

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALKSNE, J. F. & SMITH, R. W. - Iron-acrylic compound for stereotaxic aneurysms thrombosis. J. Neurosurg. 47:137, 1977.

[2] 2. BANK, W. O.; KERBER, C. W.; DRAYER, B. P.; TROOST, B. T. & MAROON, J. C. - Fistule carotido-caverneuse: occlusion endo-artérielle par cyanoacrylate avec conservation du flux carotidien. J. Neuroradiol. (Paris) 5:279, 1978.

[3] 3. CHOU, S. N.; ORTIZ-SUAREZ, H. J. & BROWN Jr., W. E. - Technique and material for coating aneurysms. Clin. Neurosurg. 21:182, 1974.

[4] 4. DAVIS, D. O. & RUMBAUGH, C. L. - Cerebral angiography in the dog: method for consistent results. Invest. Radiol. 2:323, 1967.

[5] 5. De La TORRE, E.; NETSK, M. G. & MESCHAM, I. - Intracranial and extracranial circulation in the dog: anatomic and angiographic studies. Am. J. Anat. 105:343, 1959.

[6] 6. DUTTON, J. & YATES, P. O. - An experimental study of the effects of a plastic adhesive, methyl- 2-cyanoacrylate monomer (M2C-1) in various tissues. J. Neurosurg. 24:876, 1966.

[7] ⁷
Ethicon Bucrylat: Klebstoff für menschlicres gewebe. In Ethicon Fortschrifte für die Chirurgie. Ethicon GmbH. 2 Hamburg-Norderstedt, 1972.

[8] 8. GENEST, A. S. - Experimental use of intraluminal plastic in the treatment of carotid aneurysms: preliminary report. J. Neurosurg. 22:136, 1965.

[9] 9. HILAL, S. K. & MICHELSEN, J. W. - Therapeutic percutaneous embolization for extra-axial vascular lesions of the head, neck and spine. J. Neurosurg. 43:275, 1975.

[10] 10. MANAKA, S.; IZAWA, M. & NAWATA, H. - Dural arteriovenous malformation treated by artificial embolization with liquid silicone. Surg. Neurol. 7:63, 1977.

[11] 11. MARGOLIS, M. T.; FREENY, P. C. & KENDRICK, M. M. - Cyanoacrylate occlusion of a spinal cord arteriovenous malformation. Case report. J. Neurosurg. 51:107, 1979.

[12] 12. MAZUR, J. B. & SALAZAR, J. L. - Late thrombosis of middle cerebral artery following clipping and coating of aneurysms. Surg. Neurol. 10:131, 1978.

[13] 13. Method of focal spot image and mesurements. Report of the International Comission on Radiological Units and Measurements. Am. J. Roentgen. 85:191, 1961.

[14] 14. SANO, K.; JIMBO, M.; SAITO, I. & BASUGI, N. - Artificial embolization of inoperable angioma with polymerizing substante. In H. W. Pia, J. R. W. Gleave, E. Grote e J. Zierski, ed. - Cerebral Angiomas. Springer-Verlag, Berlin, 1975, P. 221.

[15] 15. SANO, K.; JIMBO, M.; SAITO, I.; TERAO, H. & HIRAKAWA, K. - Artificial embolization with liquid plastic. Neurol. Med.-Chir. (Tokyo) 8:198, 1966.

[16] 16. SELVERSTONE, B. - Coating of intracranial aneurysms with nontoxic adherent plastics. In H. H. Schmidek e W. H. Sweet, ed. - Current Techniques in Operative Neurosurgery. Grune & Stratton, New York, 1977, p. 31.

[17] 17. SIQUEIRA, M. G.; ROJAS, R. A. G. & STURION. D. J. - Aneurismas experimentais: Proposição de nova técnica. Arq. Neuro-Psiquiat. (São Paulo) 38:18, 1980.

[18] 18. SMITH, R. "W. & ALKSNE, J. F. - Stereotaxic thrombosis of inacessible intra-cranial aneurysms. J. Neurosurg. 47:833, 1977.

[19] 19. TROUPP, H. & RINNE, T. - Methyl 2-cyanoacrylate (Eastman 910) in experimental vascular surgery. With a note on experimental arterial aneurysms. J. Neurosurg. 21:1067, 1964.

[20] 20. TSUCHIYA, G.; SUGAR, O.; YASHON, D. & HUBBARD, J. - Reactions of rabbit brain and peripheral vessels to plastics used in coating arterial aneurysms. J. Neurosurg. 28:409, 1968.

[21] 21. VANDER ARK, G. D.; PITKETHLY, D. T.; DUCKER, T. B. & KEMPE, L. G. Repair of cerebrospinal fluid fistulas using a tissue adhesive. J. Neurosurg. 33:151, 1970.

[22] 22. YASHON, D.; JANE, J. A.; GORDON, M. C; HUBBARD. J. L. & SUGAR, O. -Effects of methyl 2-cyanoacrylate adhesives on the somatic vessels and the central nervous system of animals. J. Neurosurg. 24:883, 1966.

[23] 23. YODH, S. B. & WRIGHT, R. L. - Experimental evaluation of four synthetic adhesives for possible treatment of aneurysms. J. Neurosurg. 26:504, 1967.

[24] 24. YODH, S. B. & WRIGHT, R. L. - Experimental evaluation of synthetic adhesives by intra-arterial injection. Neurochirurgia (Stuttgart) 13:118, 1970.

[25] 25. ZANETTI, P. H. & SHERMAN, F. E. - Experimental evaluation of a tissue adhesive as an agent for the treatment of aneurysms and arteriovenous anomalies. J. Neurosurg. 36:72, 1972.