造影导管空间构象及参数变化对脑血管造影经桡动脉入路所致血管路径改变的影响机制研究

As the golden standard of diagnostic method of cerebral vascular disease, cerebral angiography has always been carried out through femoral artery. Compared to femoral artery approach, radial artery approached cerebral angiography is easier to nursing after the operation and has higher comfort level as well as less surgical complications. So it was supported by some researchers that radial artery approach could serve as the standard approach for cerebral angiography. However some technique limits have been found through the clinical application of transradial cerebral angiography, especially, the low rate of successful catheterization of secondary arteries above the aortic arch through radial artery would affect the evaluation of small vessels. Previous studies show, blood vessel path changing lead to cumbersome, complex, high difficulty related with many factors, these factors include catheter difficulties into a loop, catheter stability is poor when selective catheterization and poor morphology before intubation. The catheter conformation can change the shape before catheterization, so the surgical procedures can be simplified. And it seems to change the catheter and cannula fulcrum position to have an impact on the stability of the catheter.We conclude: catheter conformation and parameters changes have impact on catheter into the loop, stability of super-selective catheterization and success rate of selective catheterization, by the means of change the catheter morphological before catheterization, changes the pivot position in the blood vessels and the size of different parts of catheter. The project is to prepare catheter with different conformational space and parameters, explore the mechanism of parameters and conformational space change on the catheter into the loop, stability of super-selective catheterization and morphology before catheterization, by simulating cerebral angiography surgery. For reduce the difficulty of operation and provide ideas and targets to design new catheter.

脑血管造影作为诊断脑血管病的金标准可选择从桡动脉或股动脉入路进行。由于穿刺部位并发症少、术后不需卧床等优势使得经桡动脉入路具有潜在优势，但该入路手术繁琐、复杂、难度高而难以在临床普及。课题申请者以往实验中发现，手术繁琐、复杂、难度高与血管路径改变导致导管成袢困难、选择性插管时导管稳定性差、插管前形态不佳等因素有关。而导管空间构象改变了导管插管前的形态、可以简化手术步骤。并似乎可改变导管插管时支点的位置，从而对导管的稳定性产生影响。我们推论：导管空间构象及参数的变化能通过影响导管插管前的形态、改变导管在血管内的支点位置及导管不同部位的尺寸从而对导管在血管内成袢、超选择性插管时的稳定性、选择性插管的成功率产生影响。本课题拟备置各种空间构象及参数的导管，通过模拟脑血管造影手术，探讨空间构象及参数变化对导管成袢、插管时的稳定性、插管前形态的影响机制，为降低手术难度、设计新导管提供思路与靶点。

背景 经桡动脉入路脑血管造影具有潜在价值，但该入路手术过程繁琐、难度高而难以在临床普及。前期研究我们发现，血管路径改变导致导管在主动脉弓内成袢困难、插管时导管稳定性差、插管前形态不佳。而导管空间构象及参数变化能通过影响以上因素提高插管成功率、降低手术难度。 .研究目的 探讨空间构象及参数变化对导管成袢、插管时的稳定性、插管前形态的影响机制，为降低手术难度、设计新导管提供思路与靶点。.研究方法 采用蒸汽塑形的方法对导管空间构象及参数进行变化，在3D打印的血管模型中模拟脑血管造影过程。观察空间构象及参数变化对导管成袢、插管时的稳定性、插管成功率等的影响。.结果 1.在导管空间构象变化组中，导管远端旋转组从0-360度间隔45度取5种外型的导管。导管近端旋转组以导管长段及弧形段所在平面为中轴进行顺时针及逆时针旋转，间隔30度取7种外型的导管。这两组导管形状改变主要影响了选择性插管时间及插管成功率并间接改变了导管参数；2.导管参数变化组中，导管远端参数变化组在1.0cm-3.0cm间，间隔0.5cm分五个组。短导管段在2.0cm-6.0cm间，间隔1.0cm分五个组。弧形段在1.0cm-3.0cm间，间隔0.5cm分五个组。导管的参数变化主要影响导管在主动脉弓内的成袢过程及对主动脉弓上二级分支血管的选择性插管成功率；3.导管空间构象及参数优化方案组选出的最优外形为导管右侧弯曲，最优参数为弧形段2.0cm、短导管段6.0cm、导管远端2.0cm。新导管有较高的左椎动脉插管成功率并能部分简化手术步骤。.结论 1.导管空间构象及参数变化对导管在主动脉弓内成袢、导管插管前形态、插管时导管的稳定性及导管选择性插管成功率均有影响；2. 导管空间构象变化由于改变了导管与主动脉弓血管内壁间的关系、改变了导管头与主动脉弓上血管开口的关系、间接改变导管参数、因此在上述影响中占主导地位，而参数变化则起次要作用；3.筛选的新外形导管拥有恰当的参数与空间构象，在经桡动脉入路脑血管造影中，能简化手术步骤，缩短手术时间并提高左侧椎动脉的选择性插管成功率。