经心经动脉超声联合透视引导胎儿栓塞术治疗Galen静脉畸形的胎羊临床前研究
该临床前研究在胎羊中评估了经心经动脉超声及透视引导下栓塞术（FETTUS）的可行性与安全性，靶血管为颌内动脉，使用N-丁基氰基丙烯酸酯栓塞。在相当于人类30周胎龄的胎羊中技术成功率高，未见非靶栓塞、缺血或出血，提示该产前经动脉途径可行且安全。
要点
- FETTUS在胎羊中技术可行，130天胎龄组栓塞成功率为100%。
- 120天胎龄组成功率为86%，100天胎龄组为33%。
- 术后30分钟尸检未见非靶栓塞、缺血或出血。
核心结论
- FETTUS在相当于人类30周胎龄的胎羊中可行且安全。
研究设计与样本
- 临床前动物研究，先在新生羊羔行MR血管成像选定靶动脉，后在胎羊中标准化FETTUS操作。
- 胎羊在母胎麻醉下经超声引导左心室入路，透视下将微导管推进至靶动脉并以N-丁基氰基丙烯酸酯栓塞。
主要发现
- 130天胎龄（足月145天，体重2.8±0.6 kg）胎羊3只全部栓塞成功（100%）。
- 100天胎龄（体重0.9±0.3 kg）6只中2只成功（33%）。
- 120天胎龄（体重2.3±0.4 kg）7只中6只成功（86%）。
- 术后30分钟观察范围内尸检未见非靶栓塞、缺血或出血。
关键数值与推荐
- 主要结局为确认栓塞后胎儿存活≥30分钟。
- 靶血管为颌内动脉，栓塞剂为N-丁基氰基丙烯酸酯。
临床怎么用
- 为Galen静脉畸形产前经动脉栓塞提供临床前可行性依据。
- 提示FETTUS可作为胎儿治疗潜在新途径，但尚需进一步转化研究。
局限性
- 仅为胎羊临床前研究，样本量有限。
- 术后观察时间仅30分钟，长期安全性未评估。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: Vein of Galen malformation is associated with significant perinatal morbidity and mortality. Postnatal management typically relies on transarterial embolization of the feeding arteries. To date, fetal therapeutic efforts focused on the transvenous approach. This study aimed to preclinically evaluate the feasibility and safety of a prenatal transarterial approach: Fetal Embolization via Transcardiac Transarterial Ultrasound- and fluoroscopy-guided Surgery (FETTUS). METHOD: MR-angiography was initially performed in neonatal lambs to identify a target artery for embolization. FETTUS was then standardized in fetal lambs at varying gestational ages. Under maternal-fetal anesthesia, laparotomy-assisted fetal left ventricular access was obtained under ultrasound guidance, a microcatheter was advanced to the target artery under fluoroscopy, and embolization was performed with N-butyl cyanoacrylate. The primary outcome was fetal survival ≥ 30 minutes after confirmed embolization. RESULTS: The internal maxillary artery was chosen as the target artery for embolization. Three fetal lambs underwent successful embolization (100%) at 130 days of gestation (term = 145 days; 2.8 ± 0.6 kg), two out of six (33%) at 100 days of gestation (0.9 ± 0.3 kg) and finally 6 out of 7 (86%) at 120 days of gestation (2.3 ± 0.4 kg). No non-target embolization, ischemia, or hemorrhage was observed on postmortem examination within the limitations of the observations obtained at 30 minutes after the procedure. CONCLUSIONS: FETTUS is feasible and safe in fetal lambs at a gestational age equivalent to 30 weeks in humans.
引用
- Van den Eede E, Chen K, Altman C, et al. Novel Fetal Embolization Technique via Transcardiac Transarterial Ultrasound- and Fluoroscopy-Guided Endovascular Surgery for Vein of Galen Malformation: Preclinical Study in the Fetal Lamb. Prenat Diagn. 2026. PMID: 42025927. doi:10.1002/pd.70157
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。