颅内动脉瘤血管内治疗现状与进展
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摘要
颅内动脉瘤破裂出血具有极高的致残率和致死率。随着技术方法 、材料发展及神经介入医师经验积累,血管内治疗已成为降低破裂颅内动脉瘤再出血率和死亡率的首选治疗方法。血管内治疗主要历经载瘤动脉和动脉瘤闭塞、动脉瘤瘤腔内栓塞和载瘤动脉重建等3个研究阶段,其中应用最广泛的是瘤腔内栓塞治疗,包括单纯弹簧圈、液体栓塞剂、瘤腔内栓塞装置、球囊/支架辅助技术等。载瘤动脉重建(覆膜支架和血流导向装置)也是近期研究热点。尽管新材料和新技术发展,但难治性动脉瘤如宽颈动脉瘤血管内治疗复发率仍较高。为了完全隔绝颅内动脉瘤或实现瘤颈完全内皮化,载药弹簧圈/支架、生物可降解支架等正在研究中。
Ruptured intracranial aneurysm with bleeding has high morbidity and mortality. With the advancement of technology, the development of materials and the accumulation of experience of neuro-interventional physicians, endovascular therapy has become the first choice for reducing the rate of re-bleeding and mortality of ruptured intracranial aneurysms. Endovascular therapy has mainly gone through three stages of research, including, in chronological order, the occlusion of the parent artery of aneurysm and the aneurysm itself in the first stage, the embolization of aneurysmal cavity in the second stage, and the reconstruction of the parent artery of aneurysm in the third stage. The most widely used treatment among the above therapies is the embolization of aneurysmal cavity with various embolization materials or techniques,which include simple spring coil, liquid embolizing agent, embolization device for aneurysmal cavity,balloon/stent-assisted technique, etc. The reconstruction of the parent artery of aneurysm(covered stent and flow diverter device) is a hot spot of recent researches. Despite the development of new materials and technologies, the recurrence rate of intractable aneurysms, such as wide-necked aneurysms, is still very high. In order to completely isolate intracranial aneurysm or to achieve complete endothelialization of the aneurysmal neck, the new kind of stent and new materials of stent such as drug-eluting coils and stents,biodegradable stents, etc. are being studied at present.
Ruptured intracranial aneurysm with bleeding has high morbidity and mortality. With the advancement of technology, the development of materials and the accumulation of experience of neuro-interventional physicians, endovascular therapy has become the first choice for reducing the rate of re-bleeding and mortality of ruptured intracranial aneurysms. Endovascular therapy has mainly gone through three stages of research, including, in chronological order, the occlusion of the parent artery of aneurysm and the aneurysm itself in the first stage, the embolization of aneurysmal cavity in the second stage, and the reconstruction of the parent artery of aneurysm in the third stage. The most widely used treatment among the above therapies is the embolization of aneurysmal cavity with various embolization materials or techniques,which include simple spring coil, liquid embolizing agent, embolization device for aneurysmal cavity,balloon/stent-assisted technique, etc. The reconstruction of the parent artery of aneurysm(covered stent and flow diverter device) is a hot spot of recent researches. Despite the development of new materials and technologies, the recurrence rate of intractable aneurysms, such as wide-necked aneurysms, is still very high. In order to completely isolate intracranial aneurysm or to achieve complete endothelialization of the aneurysmal neck, the new kind of stent and new materials of stent such as drug-eluting coils and stents,biodegradable stents, etc. are being studied at present.
引文
[1]Li MH,Chen SW,Li YD,et al.Prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years:a cross-sectional study[J].Ann Intern Med,2013,159:514-521.
[2]Alaraj A,Wallace A,Dashti R,et al.Balloons in endovascular neurosurgery:history and current applications[J].Neurosurgery,2014,74:S163-S190.
[3]Molyneux A,Kerr R,Stratton I,et al.International subarachnoid aneurysm trial(ISAT)of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms:a randomised trial[J].Lancet,2002,360:1267-1274.
[4]Molyneux AJ,Birks J,Clarke A,et al.The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms:18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial(ISAT)[J].Lancet,2015,385:691-697.
[5]Vallee JN,Pierot L,Bonafe A,et al.Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils:predictors of immediate anatomic and clinical results[J].AJNR Am J Neuroradiol,2004,25:298-306.
[6]Wakhloo AK,Gounis MJ,Sandhu JS,et al.Complex-shaped platinum coils for brain aneurysms:higher packing density,improved biomechanical stability,and midterm angiographic outcome[J].AJNR Am J Neuroradiol,2007,28:1395-1400.
[7]Gaba RC,Ansari SA,Roy SS,et al.Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils:effects on packing density,coil length and quantity,procedure performance,cost,length of hospital stay,and durability of therapy[J].Stroke,2006,37:1443-1450.
[8]Serafin Z,Di Leo G,Palys AA,et al.Follow-up of cerebral aneurysm embolization with hydrogel embolic system:systematic review and meta-analysis[J].Eur J Radiol,2015,84:1954-1963.
[9]Murayama Y,Tateshima S,Gonzalez NR,et al.Matrix and bioabsorbable polymeric coils accelerate healing of intracranial aneurysms-long-term experimental study[J].Stroke,2003,34:2031-2037.
[10]Taschner CA,Leclerc X,Rachdi H,et al.Matrix detachable coils for the endovascular treatment of intracranial aneurysms:analysis of early angiographic and clinical outcomes[J].Stroke,2005,36:2176-2180.
[11]Pierot L,Cognard C,Ricolfi F,et al.Mid-term anatomic results after endovascular treatment of ruptured intracranial aneurysms with Guglielmi detachable coils and Matrix coils:analysis of the CLARITY series[J].AJNR Am J Neuroradiol,2012,33:469-473.
[12]Molyneux AJ,Clarke A,Sneade M,et al.Cerecyte coil trial:angiographic outcomes of a prospective randomized trial comparing endovascular coiling of cerebral aneurysms with either cerecyte or bare platinum coils[J].Stroke,2012,43:2544-2550.
[13]Raymond J,Leblanc P,Desfaits AC,et al.In situ beta radiation to prevent recanalization after coil embolization of cerebral aneurysms[J].Stroke,2002,33:421-427.
[14]Raymond J,Roy D,Leblanc P,et al.Endovascular treatment of intracranial aneurysms with radioactive coils:initial clinical experience[J].Stroke,2003,34:2801-2806.
[15]Asnafi S,Rouchaud A,Pierot L,et al.Efficacy and safety of the Woven Endo Bridge(WEB)device for the treatment of intracranial aneurysms:a systematic review and meta-analysis[J].AJNR Am J Neuroradiol,2016,37:2287-2292.
[16]Kwon SC,Ding YH,Dai D,et al.Preliminary results of the luna aneurysm embolization system in a rabbit model:a new intrasaccular aneurysm occlusion device[J].AJNR Am J Neuroradiol,2011,32:602-606.
[17]Aguilar Perez M,Bhogal P,Martinez Moreno R,et al.The Medina Embolic Device:early clinical experience from a single center[J].J Neurointerv Surg,2017,9:77-87.
[18]高不郎,李明华.使用液体栓塞剂Onyx治疗颅内动脉瘤[J].介入放射学杂志,2006,15:118-121.
[19]Campi A,Ramzi N,Molyneux AJ,et al.Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial(ISAT)[J].Stroke,2007,38:1538-1544.
[20]Pierot L,Cognard C,Anxionnat R,et al.Remodeling technique for endovascular treatment of ruptured intracranial aneurysms had a higher rate of adequate postoperative occlusion than did conventional coil embolization with comparable safety[J].Radiology,2011,258:546-553.
[21]Lopes D,Sani S.Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent[J].Neurosurgery,2005,56:E416.
[22]Wakhloo AK,Schellhammer F,de Vries J,et al.Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms:an experimental study in a canine model[J].AJNR Am J Neuroradiol,1994,15:493-502.
[23]Zhang X,Zhong J,Gao H,et al.Endovascular treatment of intracranial aneurysms with the LVIS device:a systematic review[J].J Neurointerv Surg,2016,9:553-557.
[24]Muhl-Benninghaus R,Simgen A,Reith W,et al.The Barrel stent:new treatment option for stent-assisted coiling of widenecked bifurcation aneurysms.Results of a single-center study[J].J Neurointerv Surg,2017,9:1219-1222.
[25]Brassel F,Grieb D,Meila D,et al.Endovascular treatment of complex intracranial aneurysms using Acandis Acclino stents[J].J Neurointerv Surg,2017,9:854-859.
[26]Gory B,Aguilar-Perez M,Pomero E,et al.One-year angiographic results after p CONus stent-assisted coiling of 40 wide-neck middle cerebral artery aneurysms[J].Neurosurgery,2017,80:925-933.
[27]Spiotta AM,Derdeyn CP,Tateshima SA,et al.Results of the ANSWER trial using the Pulse Rider for the treatment of broadnecked,bifurcation aneurysms[J].Neurosurgery,2017,81:56-65.
[28]Yavuz K,Geyik S,Cekirge S,et al.Double stent-assisted coil embolization treatment for bifurcation aneurysms:immediate treatment results and long-term angiographic outcome[J].AJNR Am J Neuroradiol,2013,34:1778-1784.
[29]Saatci I,Cekirge HS,Ozturk MH,et al.Treatment of internal carotid artery aneurysms with a covered stent:experience in 24patients with mid-term follow-up results[J].AJNR Am J Neuroradiol,2004,25:1742-1749.
[30]Li MH,Li YD,Tan HQ,et al.Treatment of distal internal carotid artery aneurysm with the willis covered stent:a prospective pilot study[J].Radiology,2009,253:470-477.
[31]李明华.一种新型的脑动脉瘤血管内治疗技术——脑血管覆膜支架术的问世[J].介入放射学杂志,2010,19:253-256.
[32]Vulev I,Klepanec A,Bazik R,et al.Endovascular treatment of internal carotid and vertebral artery aneurysms using a novel pericardium covered stent[J].Interv Neuroradiol,2012,18:164-171.
[33]Rouchaud A,Ramana C,Brinjikji W,et al.Wall apposition is a key factor for aneurysm occlusion after flow diversion:a histologic evaluation in 41 rabbits[J].AJNR Am J Neuroradiol,2016,37:2087-2091.
[34]Marosfoi M,Langan ET,Strittmatter L,et al.In situ tissue engineering:endothelial growth patterns as a function of flow diverter design[J].J Neurointerv Surg,2017,9:994-998.
[35]Szikora I,Turanyi E,Marosfoi M.Evolution of Flow-diverter endothelialization and thrombus organization in giant fusiform aneurysms after flow diversion:a histopathologic study[J].AJNR Am J Neuroradiol,2015,36:1716-1720.
[36]Lin N,Lanzino G,Lopes DK,et al.Treatment of distal anterior circulation aneurysms with the pipeline embolization device:a US multicenter experience[J].Neurosurgery,2016,79:14-22.
[37]Griessenauer CJ,Ogilvy CS,Foreman PM,et al.Pipeline embolization device for small intracranial aneurysms:evaluation of safety and efficacy in a multicenter cohort[J].Neurosurgery,2017,80:579-587.
[38]Lubicz B,Van der Elst O,Collignon L,et al.Silk flow-diverter stent for the treatment of intracranial aneurysms:a series of 58patients with emphasis on long-term results[J].AJNR Am J Neuroradiol,2015,36:542-546.
[39]Wakhloo AK,Lylyk P,de Vries J,et al.Surpass flow diverter in the treatment of intracranial aneurysms:a prospective multicenter study[J].AJNR Am J Neuroradiol,2015,36:98-107.
[40]Luecking H,Engelhorn T,Lang S,et al.FRED flow diverter:a study on safety and efficacy in a consecutive group of 50 patients[J].AJNR Am J Neuroradiol,2017,38:596-602.
[41]Briganti F,Leone G,Ugga L,et al.Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 flow modulation device:a multicenter experience[J].J Neurointerv Surg,2017,9:70-76.
[42]Zhou Y,Yang PF,Fang YB,et al.A novel flow-diverting device(Tubridge)for the treatment of 28 large or giant intracranial aneurysms:a single-center experience[J].AJNR Am J Neuroradiol,2014,35:2326-2333.
[43]Wang W,Wang YL,Chen M,et al.Magnesium alloy covered stent for treatment of a lateral aneurysm model in rabbit common carotid artery:an in vivo study[J].Sci Rep,2016,6:37401.
[44]Arat A,Daglioglu E,Akmangit I,et al.Bioresorbable vascular scaffolds in interventional neuroradiology[J].Clin Neuroradiol,2017,[Epub ahead of print].
[45]Boileau X,Zeng H,Fahed R,et al.Bipolar radiofrequency ablation of aneurysm remnants after coil embolization can improve endovascular treatment of experimental bifurcation aneurysms[J].J Neurosurg,2017,126:1537-1544.
[46]Wang JB,Zhou B,Gu XL,et al.Treatment of a canine carotid artery aneurysm model with a biodegradable nanofiber-covered stent:a prospective pilot study[J].Neurol India,2013,61:282-287.
[47]Rudolph A,Teske M,Illner S,et al.Surface modification of biodegradable polymers towards better biocompatibility and lower thrombogenicity[J].PLo S One,2015,10:e0142075.
[48]Mallik AS,Nuss K,Kronen PW,et al.A new-generation,lowpermeability flow diverting device for treatment of saccular aneurysms[J].Eur Radiol,2014,24:12-18.
[49]Aronson JP,Mitha AP,Hoh BL,et al.A novel tissue engineering approach using an endothelial progenitor cell-seeded biopolymer to treat intracranial saccular aneurysms[J].J Neurosurg,2012,117:546-554.
[2]Alaraj A,Wallace A,Dashti R,et al.Balloons in endovascular neurosurgery:history and current applications[J].Neurosurgery,2014,74:S163-S190.
[3]Molyneux A,Kerr R,Stratton I,et al.International subarachnoid aneurysm trial(ISAT)of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms:a randomised trial[J].Lancet,2002,360:1267-1274.
[4]Molyneux AJ,Birks J,Clarke A,et al.The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms:18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial(ISAT)[J].Lancet,2015,385:691-697.
[5]Vallee JN,Pierot L,Bonafe A,et al.Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils:predictors of immediate anatomic and clinical results[J].AJNR Am J Neuroradiol,2004,25:298-306.
[6]Wakhloo AK,Gounis MJ,Sandhu JS,et al.Complex-shaped platinum coils for brain aneurysms:higher packing density,improved biomechanical stability,and midterm angiographic outcome[J].AJNR Am J Neuroradiol,2007,28:1395-1400.
[7]Gaba RC,Ansari SA,Roy SS,et al.Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils:effects on packing density,coil length and quantity,procedure performance,cost,length of hospital stay,and durability of therapy[J].Stroke,2006,37:1443-1450.
[8]Serafin Z,Di Leo G,Palys AA,et al.Follow-up of cerebral aneurysm embolization with hydrogel embolic system:systematic review and meta-analysis[J].Eur J Radiol,2015,84:1954-1963.
[9]Murayama Y,Tateshima S,Gonzalez NR,et al.Matrix and bioabsorbable polymeric coils accelerate healing of intracranial aneurysms-long-term experimental study[J].Stroke,2003,34:2031-2037.
[10]Taschner CA,Leclerc X,Rachdi H,et al.Matrix detachable coils for the endovascular treatment of intracranial aneurysms:analysis of early angiographic and clinical outcomes[J].Stroke,2005,36:2176-2180.
[11]Pierot L,Cognard C,Ricolfi F,et al.Mid-term anatomic results after endovascular treatment of ruptured intracranial aneurysms with Guglielmi detachable coils and Matrix coils:analysis of the CLARITY series[J].AJNR Am J Neuroradiol,2012,33:469-473.
[12]Molyneux AJ,Clarke A,Sneade M,et al.Cerecyte coil trial:angiographic outcomes of a prospective randomized trial comparing endovascular coiling of cerebral aneurysms with either cerecyte or bare platinum coils[J].Stroke,2012,43:2544-2550.
[13]Raymond J,Leblanc P,Desfaits AC,et al.In situ beta radiation to prevent recanalization after coil embolization of cerebral aneurysms[J].Stroke,2002,33:421-427.
[14]Raymond J,Roy D,Leblanc P,et al.Endovascular treatment of intracranial aneurysms with radioactive coils:initial clinical experience[J].Stroke,2003,34:2801-2806.
[15]Asnafi S,Rouchaud A,Pierot L,et al.Efficacy and safety of the Woven Endo Bridge(WEB)device for the treatment of intracranial aneurysms:a systematic review and meta-analysis[J].AJNR Am J Neuroradiol,2016,37:2287-2292.
[16]Kwon SC,Ding YH,Dai D,et al.Preliminary results of the luna aneurysm embolization system in a rabbit model:a new intrasaccular aneurysm occlusion device[J].AJNR Am J Neuroradiol,2011,32:602-606.
[17]Aguilar Perez M,Bhogal P,Martinez Moreno R,et al.The Medina Embolic Device:early clinical experience from a single center[J].J Neurointerv Surg,2017,9:77-87.
[18]高不郎,李明华.使用液体栓塞剂Onyx治疗颅内动脉瘤[J].介入放射学杂志,2006,15:118-121.
[19]Campi A,Ramzi N,Molyneux AJ,et al.Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial(ISAT)[J].Stroke,2007,38:1538-1544.
[20]Pierot L,Cognard C,Anxionnat R,et al.Remodeling technique for endovascular treatment of ruptured intracranial aneurysms had a higher rate of adequate postoperative occlusion than did conventional coil embolization with comparable safety[J].Radiology,2011,258:546-553.
[21]Lopes D,Sani S.Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent[J].Neurosurgery,2005,56:E416.
[22]Wakhloo AK,Schellhammer F,de Vries J,et al.Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms:an experimental study in a canine model[J].AJNR Am J Neuroradiol,1994,15:493-502.
[23]Zhang X,Zhong J,Gao H,et al.Endovascular treatment of intracranial aneurysms with the LVIS device:a systematic review[J].J Neurointerv Surg,2016,9:553-557.
[24]Muhl-Benninghaus R,Simgen A,Reith W,et al.The Barrel stent:new treatment option for stent-assisted coiling of widenecked bifurcation aneurysms.Results of a single-center study[J].J Neurointerv Surg,2017,9:1219-1222.
[25]Brassel F,Grieb D,Meila D,et al.Endovascular treatment of complex intracranial aneurysms using Acandis Acclino stents[J].J Neurointerv Surg,2017,9:854-859.
[26]Gory B,Aguilar-Perez M,Pomero E,et al.One-year angiographic results after p CONus stent-assisted coiling of 40 wide-neck middle cerebral artery aneurysms[J].Neurosurgery,2017,80:925-933.
[27]Spiotta AM,Derdeyn CP,Tateshima SA,et al.Results of the ANSWER trial using the Pulse Rider for the treatment of broadnecked,bifurcation aneurysms[J].Neurosurgery,2017,81:56-65.
[28]Yavuz K,Geyik S,Cekirge S,et al.Double stent-assisted coil embolization treatment for bifurcation aneurysms:immediate treatment results and long-term angiographic outcome[J].AJNR Am J Neuroradiol,2013,34:1778-1784.
[29]Saatci I,Cekirge HS,Ozturk MH,et al.Treatment of internal carotid artery aneurysms with a covered stent:experience in 24patients with mid-term follow-up results[J].AJNR Am J Neuroradiol,2004,25:1742-1749.
[30]Li MH,Li YD,Tan HQ,et al.Treatment of distal internal carotid artery aneurysm with the willis covered stent:a prospective pilot study[J].Radiology,2009,253:470-477.
[31]李明华.一种新型的脑动脉瘤血管内治疗技术——脑血管覆膜支架术的问世[J].介入放射学杂志,2010,19:253-256.
[32]Vulev I,Klepanec A,Bazik R,et al.Endovascular treatment of internal carotid and vertebral artery aneurysms using a novel pericardium covered stent[J].Interv Neuroradiol,2012,18:164-171.
[33]Rouchaud A,Ramana C,Brinjikji W,et al.Wall apposition is a key factor for aneurysm occlusion after flow diversion:a histologic evaluation in 41 rabbits[J].AJNR Am J Neuroradiol,2016,37:2087-2091.
[34]Marosfoi M,Langan ET,Strittmatter L,et al.In situ tissue engineering:endothelial growth patterns as a function of flow diverter design[J].J Neurointerv Surg,2017,9:994-998.
[35]Szikora I,Turanyi E,Marosfoi M.Evolution of Flow-diverter endothelialization and thrombus organization in giant fusiform aneurysms after flow diversion:a histopathologic study[J].AJNR Am J Neuroradiol,2015,36:1716-1720.
[36]Lin N,Lanzino G,Lopes DK,et al.Treatment of distal anterior circulation aneurysms with the pipeline embolization device:a US multicenter experience[J].Neurosurgery,2016,79:14-22.
[37]Griessenauer CJ,Ogilvy CS,Foreman PM,et al.Pipeline embolization device for small intracranial aneurysms:evaluation of safety and efficacy in a multicenter cohort[J].Neurosurgery,2017,80:579-587.
[38]Lubicz B,Van der Elst O,Collignon L,et al.Silk flow-diverter stent for the treatment of intracranial aneurysms:a series of 58patients with emphasis on long-term results[J].AJNR Am J Neuroradiol,2015,36:542-546.
[39]Wakhloo AK,Lylyk P,de Vries J,et al.Surpass flow diverter in the treatment of intracranial aneurysms:a prospective multicenter study[J].AJNR Am J Neuroradiol,2015,36:98-107.
[40]Luecking H,Engelhorn T,Lang S,et al.FRED flow diverter:a study on safety and efficacy in a consecutive group of 50 patients[J].AJNR Am J Neuroradiol,2017,38:596-602.
[41]Briganti F,Leone G,Ugga L,et al.Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 flow modulation device:a multicenter experience[J].J Neurointerv Surg,2017,9:70-76.
[42]Zhou Y,Yang PF,Fang YB,et al.A novel flow-diverting device(Tubridge)for the treatment of 28 large or giant intracranial aneurysms:a single-center experience[J].AJNR Am J Neuroradiol,2014,35:2326-2333.
[43]Wang W,Wang YL,Chen M,et al.Magnesium alloy covered stent for treatment of a lateral aneurysm model in rabbit common carotid artery:an in vivo study[J].Sci Rep,2016,6:37401.
[44]Arat A,Daglioglu E,Akmangit I,et al.Bioresorbable vascular scaffolds in interventional neuroradiology[J].Clin Neuroradiol,2017,[Epub ahead of print].
[45]Boileau X,Zeng H,Fahed R,et al.Bipolar radiofrequency ablation of aneurysm remnants after coil embolization can improve endovascular treatment of experimental bifurcation aneurysms[J].J Neurosurg,2017,126:1537-1544.
[46]Wang JB,Zhou B,Gu XL,et al.Treatment of a canine carotid artery aneurysm model with a biodegradable nanofiber-covered stent:a prospective pilot study[J].Neurol India,2013,61:282-287.
[47]Rudolph A,Teske M,Illner S,et al.Surface modification of biodegradable polymers towards better biocompatibility and lower thrombogenicity[J].PLo S One,2015,10:e0142075.
[48]Mallik AS,Nuss K,Kronen PW,et al.A new-generation,lowpermeability flow diverting device for treatment of saccular aneurysms[J].Eur Radiol,2014,24:12-18.
[49]Aronson JP,Mitha AP,Hoh BL,et al.A novel tissue engineering approach using an endothelial progenitor cell-seeded biopolymer to treat intracranial saccular aneurysms[J].J Neurosurg,2012,117:546-554.