(3.238.250.105) 您好!臺灣時間:2021/04/20 06:00
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:許世偉
研究生(外文):Shih-Wei Hsu
論文名稱:利用人類顱內透明血管模型研究紐偌楓微細血管支架
論文名稱(外文):Studies of the Neuroform Microstent Using Transparent Human Intracranial Arterial Model
指導教授:鄭汝汾
指導教授(外文):Yu-fang Cheng
學位類別:碩士
校院名稱:長庚大學
系所名稱:臨床醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:62
中文關鍵詞:透明血管模型紐偌楓微細血管支架動脈瘤
外文關鍵詞:transparent arterial modelNeuroform Microstentaneurysm
相關次數:
  • 被引用被引用:0
  • 點閱點閱:348
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:45
  • 收藏至我的研究室書目清單書目收藏:0
利用血管內支架輔助線圈栓塞治療顱內動脈瘤是一種新的治療技術,絕大多數用於此種治療方式之血管內支架是設計適用於心臟冠狀動脈血管。紐偌楓血管微支架(Neuroform Microstent,美商波斯頓公司)是一種全新設計具有自我伸展特性之顱內血管支架,此種支架是由鎳鈦合金製造而成。此支架已通過美國食品藥物管理局(FDA)通過適用於寬頸顱內動脈瘤。在臨床上我們遇到一些使用紐偌楓支架時的問題,其中最主要是因為此種支架在臨床操作時,X光透視下是無法被看見。此實驗主要的目地是利用製作透明人類血管模型技術去探討紐偌楓支架之物理機械性質。共有12支紐偌楓支架置放至8條不同片段之人類顱內動脈,包括脊椎基底、內頸動脈及大腦等動脈。已置放支架之動脈再經過標準脫水程序,然後再浸潤至甲基水楊酸溶液而使動脈變成透明血管。紐偌楓支架在這些透明動脈內之情形則利用放大數位照像的方式研究。紐偌楓支架同時也利用壓力變形曲線的方法來研究其輻射張力。大致而言紐偌楓支架有很好的順服性,但是有以下幾點可能值得注意的缺點:(A)支架部分的環冠可能會突出到模擬動脈瘤頸部,(B)在有大角度之血管環冠間隙比我們預期的大,(C)支架的緃向回復力使一小段的血管變直。雖然人類透明顱內動脈模型有一些限制,但是用於研究紐偌楓支架之物理機械特性仍是一很好的研究模型。大小合適的血管是確定支架在血管內有良好的順服性。在彎曲血管中支架的置放可能有問題,包括有過大的間隙以及支架的緃向回復力。紐偌楓支架在壓縮變形測試中得知在直徑百分之40內的壓縮其輻射張力是屬一純線性的彈性張力,而支架端點之輻射張力較中間部分較小且有顯著差異。
Combination of endovascular stent and coils embolization in the treatment of intracranial aneurysm is a relatively new therapeutic technique. Most of the stents that used in this method were designed for coronary artery. NeuroformTM Microstent (Target Therapeutic/Boston Scientific) is a newly designed intracranial self-expandable stent and is constructed by nickel-titanium alloy. The stent has been proved by FDA in the treatment of wide neck intracranial aneurysm as the assisted device in the coil embolization. A variety of technical difficulties have been encountered using Neuroform stent, in part because of poor visibility of the stent under fluoroscopy during the procedure. The purpose of this study was to assess the mechanics of the Neuroform Microstent by direct visualization within transparent human intracranial arteries. Eight various segments of human intracranial arteries including vertibrobasilar, carotid artery and cerebral arteries were used. Twelve Neuroform stents, including Neuroform 2 (NF2) were deployed into the arteries. The stented arteries were then dehydrated followed by cleared in Methyl Salicylate to obtain transparent arteries. Morphological situations of Neuroform stents were studied by macro digital photography. The radial force of Neuroform stent was studied by stress-strain curve using deformation compression test. The Neuroform stent exhibited good conformity to arterial segments, however, a few important and potentially adverse properties were seen such as: (A) portions of the crown of Neuroform stent may protrude into larger side branches which was mimic the neck of an aneurysm; (B) the gap between stent crowns could be larger than expected in arterial segments with acute or abrupt angulation; (C) the longitudinal rebounding force exerted by NF stent in acute angulation could straighten the short and small arterial segment. Transparent human intracranial artery is an excellent model for evaluating the physical properties and behaviors of Neuroform stent although some limitations are noted regarding to the physical properties. Proper sizing is important for ensuring good stent conformity within the arterial segments. Neuroform stent deployment in acute angulation could be problematic, resulting in excessive gaps between crown segments and exerting a longitudinal rebounding force against arterial wall. The deformation compression test of NF stent revealed that the stent is a purely elastic deformation stent within 40% of diameter compressed. The radial force at the end of the stent is lesser than at the central portion of the stent with statistically significant.
第一章、前言
1.1 顱內動脈瘤
1.2 流行病學
1.3 顱內動脈瘤之治療
1.4 古利氏可脫離式線圈
1.5 血管支架
1.6 紐偌偑血管微支架
1.7 透明血管模型的
第二章、實驗目的
第三章、實驗材料與方法
3.1 人類顱內動脈
3.2 紐偌楓支架
3.3 支架置放
3.4 透明動脈
3.5 紐偌偑血管支架輻射張力

第四章、實驗結果
4.1 透明顱內動脈內之紐偌偑血管支架表現
4.2 紐偌偑血管支架輻射張力測量結果

第五章、討論

第六章、結論及未來研究方向
6.1 結論
6.2 現階段支架的改進
6.3 未來研究方向
6.3.1垂直式NF支架置放輔助寬頸動脈瘤線圈栓塞
6.3.2 蓮花支架

參考文獻
1.Osborn AG. Intracranial aneurysm. In: Osborn AG ed. Diagnostic cerebral angiography. 2nd ed. Lippincott Williams & Wilkins. Philadelphia 1999; 241-276
2.Nakagawa T, Hashi K. The incidence and treatment of asymptomatic, unruptured cerebral aneurysms. J Neurosurg 1994; 80: 217-223
3.Rinne J, Hernesniemi J, Puranen M, Saari T. Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 1994; 35: 803-808
4.Ogilvy CS, Carter BS. A prospective comprehensive grading system to predict outcome for surgical management of intracranial aneurysm. Neurosurgery 1998; 42: 957-970
5.Vinuela F, Duckwiler G, Mawad MJ. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative analysis and clinical outcome in 403 patients. J Neurosurg 1997; 86: 475-482
6.Moret J, Cognard C, Weill A, Castaings L, Rey A. The “remodeling technique” in the treatment of wide neck intracranial aneurysms: angiographic results and clinical follow-up in 56 cases. Interven Neuroradiol 1997; 3: 21-35
7.Cloft HJ, Joseph GJ, Tong FC, Goldstein JH, Dion JE. Use of three-dimensional Guglielmi detachable coils in the treatment of wide-neck cerebral aneurysms. AJNR Am J Neuroradiol 2000; 21:1312-1314
8.Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C. Endovascular reconstruction of intracranial arteries by stent placement and combined techniques. J Neurosurg 2002; 97: 1306-1313
9.Wathinson AF, Strecker EP, Boos I. Metallic stents: individual designs and characteristics. In: Adam A, Dondelinger RF, Mueller PR (ed): Textbook of Metallic Stents. Isis Medical Media Ltd, Oxford, 1997: 207-231
10.Dotter CT. Transluminal placed coilspring endarterectomy tube grafts: long-term patency in canine popliteal artery. Invest Radiol 1969; 4: 327-332
11.Maass D, Zollikofer CL, Largiader F, Senning A. Radiological follow-up of transluminally inserted vascular endoprosthesis: an experimental study using expanding spirals. Radiology 1984; 152:659-663
12.Howington JU, Hanel RA, Harrigan MR, Levy EI, Guterman LR, Hopkins LN. The Neuroform stent, the first microcatheter-delivered stent for use in the intracranial circulation. Neurosurgery 2004; 54: 2-5
13.Fiorella D, Albuquerque FC, Han P, McDougall CG. Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 2004; 54:6-7
14.Benitez RP, Silva MT, Klem J, Veznedaroglu E, Rosenwasser RH. Endovascular occlusion of wide-necked aneurysms with a new intracranial microtent (Neuroform) and detachable coils. Neurosurgery 2004; 54: 1359-1368
15.Karino T, Motomiya M. Flow visualization in isolated transparent natural blood vessels. Biorheology 1983; 20:119-127
16.Motomiya M, Karino T. Flow pattern in the human carotid artery bifurcation. Stroke 1984; 15(1): 50-56
17.Karino T, Motomiya M, Goldsmith HL. Flow patterns at the major T-junctions of the dog descending aorta. J Biomech 1990; 23:537-548
18.Gailloud P Pray JR, Muster M, Piotin M, Fasel JH, Rufenacht DA. An in vitro anatomic model of the human cerebral arteries with saccular arterial aneurysms. Surg Radiol Anat 1977; 19:119-121
19.Barath K, Cassot F, Rufenacht DA, Fasel J. Anatomically shaped internal carotid artery aneurysm in vitro model for flow analysis to evaluate stent effect. AJNR Am J Neuroradiol 2004; 25:1750-1759
20.Lossef SV, Lutz RJ, Mundorf J, Barth KH. Comparison of mechanical deformation properties of metallic stents with use of stress-strain analysis. JVIR 1994; 5:341-349
21.Dyet JF, Watts WG, Ettles DF, Nicholson AA. Mechanical properties of metallic stents: how do these properties influence the choice of stent for specific lesion? Cardiovasc Intervent Radiol 2000; 23:47-54
22.Lylyk P, Ferrario A, Pasbon B, Miranda C, Doroszuk G. Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 2005; 102:235-241
23.Fiorella F, Albuquerque FC, Deshmukh VR, McDougall CG. In-stent stenosis as a delay complication of Neuroform stent-supported coil embolization of an Incidental carotid terminus aneurysm. AJNR Am J Neuroradiol 2004; 25:1764-1767
24.Broadbent LP, Moran CJ, Cross DT, Derdeyn CP. Management of Neuroform stent dislodagement and misplacement. AJNR Am J Neuroradiol 2003; 24:1819-1822
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關論文
 
1. 林明地(民88)。家長參與學校教育研究與實際:對教育改革的啟示,教育研究資訊,7(2),61-79。
2. 林進材(民88)。促進教師教學效能的途徑,教育實習輔導季,4,45-50。
3. 林明地(民88)。家長參與學校教育研究與實際:對教育改革的啟示,教育研究資訊,7(2),61-79。
4. 吳璧如(民87) 。校(園)長與教師對家長參與學校教育的態度研究。教育研究資訊雙月刊,6(4),8-29。
5. 吳璧如(民87) 。校(園)長與教師對家長參與學校教育的態度研究。教育研究資訊雙月刊,6(4),8-29。
6. 吳清山 (民85) 。共創學校與家長會雙贏的局面。北縣教育,13,14-19。
7. 林進材(民88)。促進教師教學效能的途徑,教育實習輔導季,4,45-50。
8. 吳清山 (民85) 。共創學校與家長會雙贏的局面。北縣教育,13,14-19。
9. 楊巧玲(民90)。家長參與學校教育的社會學分析:英、美與台灣的教育改革策略之比較。教育學刊,國立高雄師範大學教育學系,17,199-217。
10. 楊巧玲(民90)。家長參與學校教育的社會學分析:英、美與台灣的教育改革策略之比較。教育學刊,國立高雄師範大學教育學系,17,199-217。
11. 詹志禹(民86)。中小學教師選聘的專業判準。北縣教育,16,33-36。
12. 詹志禹(民86)。中小學教師選聘的專業判準。北縣教育,16,33-36。
13. 陳木金(民86)國民小學教師教學效能評鑑量表編製之研究。藝術學報,第
14. 陳木金(民86)國民小學教師教學效能評鑑量表編製之研究。藝術學報,第
 
系統版面圖檔 系統版面圖檔