外伤性颈内动脉海绵窦瘘并严重鼻衄的血管内介入治疗

目的 探讨血管内介入治疗外伤性颈内动脉海绵窦瘘(TCCF)合并严重鼻衄的策略和疗效.方法 26例TCCF并严重鼻衄的患者进行了血管内介入治疗,其中24例采用了可脱性球囊栓塞瘘口或闭塞颈内动脉;1例采用解脱式微弹簧圈栓塞;1例采用覆膜支架进行治疗.结果 26例中,9例1次性栓塞了瘘口,假性动脉瘤消失,颈内动脉通畅;15例1次性栓塞了瘘口和闭塞颈内动脉;解脱式微弹簧圈栓塞海绵窦,瘘口基本消失,颈内动脉通畅1例;覆膜支架闭塞瘘口,颈内动脉保持通畅1例.术后26例均未再发生鼻衄.结论 TCCF并严重鼻衄应尽早进行DSA确诊,尽早或急症进行治疗.血管内介入治疗TCCF合并严重鼻衄是一种首选、安全和有效的治疗方法.     

覆膜支架治疗外伤性颈内动脉海绵窦瘘及颅内动脉瘤的临床分析

目的 探讨Jostent冠状动脉覆膜支架对外伤性颈内动脉海绵窦瘘(TCCF)及难治性颅内动脉瘤的血管内治疗效果.方法 自2003年10月至2009年10月四川大学华西医院神经外科应用Jostent冠状动脉覆膜支架治疗TCCF及难治性颅内动脉瘤35例,其中TCCF 15例,颈内动脉瘤11例,椎动脉瘤9例.结果 35例中33例一次性于靶动脉置人覆膜支架成功,动脉瘤(瘘)完全消除并保持载瘤动脉畅通,临床效果满意.1例TCCF及1例椎动脉夹层动脉瘤患者因血管迂曲,覆膜支架无法到达指定位置.三维数字减影血管造影随访17例,原动脉瘤(瘘)未见显示,载瘤动脉畅通.结论 对于TCCF及难治性颅内动脉瘤,覆膜支架是有效的血管内治疗手段.     

外伤性颈内动脉海绵窦瘘的血管内治疗

目的:总结应用多种血管内技术治疗外伤性颈内动脉海绵窦瘘(TCCF)的经验体会。方法:自2003年11月~2007年11月收治TCCF 16例。14例患者单纯应用可脱球囊治疗,1例应用可脱弹簧圈结合NBCA栓塞治疗,1例患者应用可脱球囊治疗失败后应用了覆膜支架治疗。结果:14例应用球囊成功栓塞瘘口,另2例分别应用可脱弹簧圈结合NBCA和覆膜支架最终治疗成功。14例闭塞瘘口并保留了颈内动脉,2例闭塞瘘口的同时闭塞了颈内动脉。无死亡以及手术相关性并发症。随访6~24个月(平均18个月),无1例复发。结论:多种血管内技术可以安全、有效地治疗外伤性颈内动脉海绵窦瘘。首选球囊闭塞瘘口,在球囊闭塞瘘口失败时可考虑应用可脱弹簧圈或覆膜支架。     

经动脉途径血管内治疗51例外伤性直接性颈动脉海绵窦瘘

目的推介最近5年经动脉途径使用可脱球囊、弹簧圈和Willis覆膜支架血管内治疗外伤性直接性颈动脉海绵窦瘘(TDCCFs)和保留颈内动脉(ICA)的经验。方法回顾性分析经动脉途径血管内治疗的51例患者的54处TDCCFs,均首选可脱球囊作为治疗方法,Willis覆膜支架和弹簧圈作为备选方法,术后3～48个月行脑血管造影和临床随访评价所有患者的治疗效果。结果一期单纯性可脱球囊成功治疗46处(85.2%)TDCCFs,并保留了ICA。使用可脱球囊、弹簧圈和Willis覆膜支架合计保留了53处(98.1%)TDCCFs的ICA,同时成功闭塞瘘口,仅1例闭塞了单侧ICA和瘘口。单纯可脱球囊治疗40处TDCCFs,单纯Willis覆膜支架治疗2处TDCCFs,单纯弹簧圈治疗1处TDCCF,可脱球囊联合Willis覆膜支架治疗8处TDCCFs,联合弹簧圈治疗3处TDCCFs,其中1处使用了Willis覆膜支架治疗。12处TDCCFs进行了二期和三期治疗。除外5例患者单侧视力损害和(或)脑神经麻痹无明显改善外,术后1 d～6个月其他病例症状呈阶梯型改善,直到消失。术中无一例患者血管破裂、无远端脑栓塞和新发神经系统症状等并发症...     

介入栓塞治疗外伤性颈动脉海绵窦瘘的疗效

目的 探讨介入栓塞治疗外伤性颈动脉海绵窦瘘(TCCF)的临床疗效及影像学变化。方法 选取77例TCCF患者的临床资料，按照不同的手术治疗方法分为球囊辅助弹簧圈栓塞(球囊辅助组35例、可脱性球囊栓塞(可脱性球囊组38例)、Willis覆膜支架栓塞(覆膜支架组4例),分析栓塞术后的影像学表现和预后。结果 77例患者共计手术84台次，行一次栓塞治疗70例，两次栓塞治疗7例。总体治愈率100%,颈内动脉通畅率97.4%。球囊辅助组与可脱性球囊组相比完全闭塞率、手术并发症发生率、一次性栓塞治愈率无明显差异。所有患者随访显示疗效可靠。结论 球囊辅助弹簧圈和可脱性球囊栓塞方法可作为治疗TCCF的首选方案，安全可靠。     

颈动脉损伤的血管内介入治疗

目的 评价采用介入技术经血管内治疗颈动脉损伤的安全性和疗效.方法 对111例经数字减影血管造影(DSA)确诊的颈动脉损伤患者进行血管内治疗.本组颅外段颈内动脉(ICA)损伤1例,采用覆膜支架封闭颈动脉破裂口),颅内段颈内动脉损伤110例,采用球囊栓塞73例,弹簧圈栓塞12例,注射α-氰基丙烯酸正丁酯(NBCA)栓塞6例,覆膜支架封闭破裂口11例,应用多种材料联合栓塞8例.结果 血管造影显示颅外段颈内动脉动静脉瘘(AVF)1例,创伤性颈动脉海绵窦瘘(TCCF)83例,创伤性颅内段颈内动脉假性动脉瘤14例,TCCF合并假性动脉瘤13例.治疗均获成功,颈动脉保留通畅62例,临床症状消失110例,好转1例.并发症2例,无死亡患者.术后跟踪随访1～14个月,其中16例经DSA复查,临床症状复发3例,其中2例经补充栓塞治愈,1例继续临床观察.结论 应用介人技术包括经导管超选择性栓塞术和覆膜支架置人术治疗颈动脉损伤是损伤小、安全且有效的方法.     

Willis覆膜支架治疗颅内段颈内动脉病变临床应用

目的 评价Willis覆膜支架治疗颅内段颈内动脉病变的效果.方法 回顾性分析2013年4月至2015年4月采用Willis覆膜支架治疗的201例颅内段颈内动脉病变患者.术后3～6个月随访复查DSA和临床观察结果.结果 Willis覆膜支架成功治疗198例颅内段颈内动脉病变,其中囊性动脉瘤88例,外伤性动脉瘤19例,假性动脉瘤35例,外伤性颈动脉海绵窦瘘56例,技术成功率达到98.5％.Willis覆膜支架释放部位依次为颈内动脉C7段9例,C6段28例,C5段32例,C4段110例,C3段19例;支架释放后即刻DSA显示病变完全不显影163例,内漏35例,经球囊后扩或再植入支架治疗后病变完全不显影33例(其中2例闭塞载瘤动脉),2例仍存在内漏.术中发生支架源性血管破裂出血5例,术中成功止血4例;术后再出血1例,死亡2例.术后3～6个月随访复查DSA显示载瘤动脉通畅189例,轻度狭窄5例;病变完全不显影196例.临床随访3～20个月,存活患者无新发神经系统体征.结论 Willis覆膜支架能够安全有效地治疗颅内段颈内动脉病变,但需要更远期随访.     

Willis覆膜支架在颈内动脉海绵窦瘘中的应用

目的 评价应用Willis覆膜支架治疗颈内动脉海绵窦瘘(CCF)的价值.方法 2014年1月至2015年7月本院采用Willis覆膜支架治疗CCF 7例,分析患者的临床资料和疗效.结果 7例患者共置入Willis覆膜支架7枚.均一次成功置入支架,术后即刻血管造影显示病变完全消失,责任动脉通畅.7例随访6例临床症状逐渐好转,无手术相关并发症,术后半年行全脑血管造影复查5例,结果显示病变消失,责任动脉均保持通畅.结论 Willis覆膜支架治疗CCF成功率高,疗效好,并发症少,可作为可脱球囊栓塞失败患者的替代治疗方法.但仍需更长期的随访和大样本多中心研究.     

Willis覆膜支架治疗外伤性颈内动脉假性动脉瘤的中期随访

目的评价Willis覆膜支架治疗外伤性颈内动脉假性动脉瘤的疗效和中期预后。方法在38例头颈部外伤患者的脑血管造影中发现了13例、14枚延迟性颈内动脉假性动脉瘤,所有假性动脉瘤使用Willis覆膜支架治疗,术后1、3、6和12个月随访脑血管造影,分为完全闭塞和不完全闭塞;临床症状随访分为完全恢复、明显改善、无明显改善和恶化。结果所有病例成功植入Willis覆膜支架,术中无一例出现并发症。最初9例假性动脉瘤完全闭塞,4例不完全闭塞;3～12个月随访造影显示12例假性动脉瘤完全闭塞,所有病例颈内动脉通畅,无明显支架内狭窄。临床随访11例完全恢复,1例改善,1例无明显改善;无致残和致死病例。结论Willis覆膜支架治疗外伤性颈内动脉假性动脉瘤是切实可行的,能够很好地保留载瘤动脉。     

带膜支架治疗右侧外伤性颈动脉海绵窦瘘一例

报道1例右侧外伤性颈动脉海绵窦瘘(traumatic carotid cavernous fistula,TCCF),采用带膜支架封堵术完全闭塞瘘口并且保持颈内动脉通畅.     

创伤性颈内动脉海绵窦瘘的介入治疗

目的:探讨不同类型的创伤性颈内动脉海绵窦瘘的介入治疗方法。材料和方法:回顾性分析63例经全脑数字减影血管造影(DSA)诊断的创伤性颈内动脉海绵窦瘘的治疗方法:血管内栓塞、栓塞结合手术孤立瘘口或瘘口所在的颈内动脉内覆膜支架置入等方式。结果:63例创伤性颈动脉海绵窦瘘中,术后59例动静脉瘘完全闭塞,4例大部分闭塞;临床症状消失62例,好转1例。本组无并发症发生。结论:创伤性颈内动脉海绵窦瘘治疗的关键在于闭塞瘘口。根据其动静脉瘘的部位、供血动脉及瘘口的数量、引流静脉的特点等综合考虑栓塞材料的选择是保证治疗成功的重要因素。     

Willis覆膜支架治疗颅段颈内动脉动脉瘤的前瞻性研究

目的评价Willis覆膜支架治疗颅段颈内动脉(ICA)动脉瘤的柔顺性和疗效。方法31例患者33枚颅段ICA(CICA)动脉瘤患者接受Willis覆膜支架治疗。根据血管造影表现,分为完全栓塞和不完全栓塞。术后第1,3,6,12个月及之后每年1次随访复查并收集最初及最终造影结果、死亡率、致残率及最终临床结果等数据。结果42枚覆膜支架中41枚顺利通过ICA并成功释放,成功率97.6%(95%CI:93%～102%)。术后即刻造影显示,23例患者中25枚为完全栓塞,占78.1%(95%CI:63%～93%);7例患者7枚动脉瘤为不完全栓塞(21.9%)。随访血管造影示27例患者共31枚动脉瘤,其中29枚完全栓塞,占93.5%(95%CI:84%～103%);2例为不完全栓塞(6.5%),其中2例患者出现轻度支架内狭窄。临床随访显示15例患者痊愈,14例症状改善。结论初步结果显示,Willis覆膜支架治疗CICA动脉瘤有效且具有良好的柔顺性,但仍需长期随访及大样本临床研究。     

创伤性颈内动脉假性动脉瘤的血管内治疗

目的 探讨载瘤动脉闭塞、弹簧圈栓塞以及支架技术治疗颅内创伤性颈内动脉假性动脉瘤(pseudoaneurysm,PSA)的适应证及其疗效.方法 本组6例患者,3例海绵窦段PSA合并颈内动脉海绵窦痿(carotid-cavernous fistula,CCF),2例单纯颈内动脉PSA,1例CCF球囊栓塞后复查显示PSA.球囊闭塞CCF及创伤性颈内动脉PSA 1例,弹簧圈栓塞3例,颈内动脉球囊闭塞2例.根据6例患者的临床表现、影像学资料、治疗方法选择、临床疗效、随访资料以及文献,分析三种治疗方式的适应证.结果 本组患者无手术相关并发症发生,无脑缺血并发症.术后无鼻出血发生,3例眼球突出回复,1例随访半年视力改善,3例颅内杂音消失,3例瞳孔缩小,复查数字减影血管造影(DSA)未见PSA复发.结论 血管内治疗是治疗颈内动脉PSA的首选,合并CCF时可行球囊闭塞或载瘤动脉闭塞.对单纯窄颈者予以弹簧圈栓塞,对宽颈的采用支架技术结合弹簧圈栓塞,而位于颈内动脉岩段可选择带膜支架.

Abstract：

Objective To investigate the indication and result of parental artery occlusion, embolization with coils, stents in treatment of the traumatic carotid artery pseudoaneurysm. Methods There were six patients with traumatic carotid artery pseudoaneurysm including three patients of cavernous pseudoaneurysm combined with carotid-cavernous fistula (CCF), two with simple traumatic carotid artery pseudoaneurysm and one with traumatic carotid artery pseudoaneurysm that was found after CCF embolization with detachable balloon. The treatment included balloon occlusion for CCF and traumatic carotid pseudoaneurysm in one patient, coil embolization in three and intenal carotid artery balloon occlusion in two. The Clinical manifestations, imaging data, choice of treatment, clinical efficacy, follow-up data and literatures were analyzed to discuss the indications for three treatments. Results There was no cerebral ischemia or surgically-related complication. No epistaxis occurred. The eyeball protrusion restoration was found in three patients and intracranial bruit vanishing in three. Vision was improved one patient after half a year follow-up. The pupils shrank in three patients during follow - up. Digital subtraction angiography (DSA) showed no recurrence of pseudoaneurysm. Conclusions Endovascular treatment is the preferred choice of treatment for traumatic carotid artery pseudoaneurysm. The occlusion or parent artery balloon occlusion can be used when the pseudoaneurysm is combined with CCF. Coil embolization can be used for shoes with narrow neck, stent technology combined with coil embolization for those with wide neck and the covered stent for the rock section of the internal carotid artery.     

Treatment of traumatic cervical arteriovenous fistulas with N-butyl-2-cyanoacrylate

We report 2 cases of traumatic arteriovenous fistulas in the neck treated with transarterial embolization with n-butyl-2-cyanoacrylate (n-BCA). In both cases, covered stent placement across the fistula to preserve the artery was not possible. Detachable coil placement was attempted in one case but was not successful. Both fistulas were successfully treated with n-BCA embolization. To our knowledge, these are the first 2 such cases reported of high-flow cervical arteriovenous fistulas treated with n-BCA embolization.     

经动脉入路血管内治疗142例创伤性颈内动脉海绵窦瘘临床分析

目的 验证经动脉入路血管内治疗对创伤性颈内动脉海绵瘘(CCF)的治疗效果.方法 142例经全脑血管造影确诊为颈内动脉海绵窦瘘,行常规可脱球囊栓塞术,其中7例行球囊栓塞失败,改为全麻下行Jostent覆膜支架成形术.结果 135例患者局麻下成功行可脱球囊栓塞术,7例行球囊栓塞失败后于全麻下成功行Jostent覆膜支架成形...     

Delayed effects in the treatment of carotid-cavernous fistulas

Carotid-cavernous fistulas may be classified into: (1) internal carotid, (2) external carotid, or (3) a combination of both. They may result from traumatic or spontaneous rupture of the carotid artery into the cavernous sinus. Intravascular embolization has become the treatment of choice for the management of carotid cavernous fistulas. The authors report the delayed effects after the treatment of carotid-cavernous fistulas with experience of 74 cases over the past 6 years. The delayed effects may be summarized as follows: (1) progressive spontaneous occlusion of the fistula after partial balloon embolization, (2) false aneurysms may decrease in size and be spontaneously sealed off, (3) transient and persistent third or sixth cranial nerve palsy may be seen in about 16% of 74 cases, (4) posttraumatic fibrosis with narrowing of the carotid artery may be apparent after total occlusion of the fistula, (5) a prematurely deflated balloon may be dislodged into the carotid artery or its branch, and (6) spontaneous obliteration of common channels from internal carotid artery may occur after total occlusion of external carotid channels in those cases with a combination of internal carotid- and external carotid-cavernous fistulas. Certainly the delayed effect will alter our future planning in the treatment of carotid cavernous fistulas.     

Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster

Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.     

Endovascular trapping of traumatic carotid-cavernous fistulae

We describe an unconventional endovascular approach to the treatment of traumatic carotid-cavernous fistulas. Four patients with large high-flow shunts have been successfully treated by trapping of the fistula by using a combination of proximal balloon occlusion and distal coil embolization. The latter was achieved following retrograde catheterization of the distal parent vessel via the contralateral carotid or ipsilateral vertebral artery.