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。     

血管内栓塞治疗外伤性颈动脉海绵窦瘘并发症的临床分析

目的 探讨血管内栓塞治疗外伤性颈动脉海绵窦瘘并发症的防治,以提高血管内栓塞治疗外伤性颈动脉海绵窦瘘的安全性.方法 回顾性分析血管内栓塞治疗65例外伤性颈动脉海绵窦瘘,其中采用可脱性球囊58例,铂金微弹簧圈栓塞7例.球囊早脱1例,早泄2例,移位1例;颈内动脉闭塞所引起的脑缺血1例,血栓形成2例,血管痉挛2例,分别进行相应的处理.结果 本组无死亡,一过性神经功能障碍3例,经积极处理后,预后良好.结论 栓塞技术的提高,栓塞材料的改进,术中、术后发生情况的正确处理,有助于降低并发症的发生率.     

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.     

可脱球囊栓塞术在海绵窦瘘治疗中的应用 (附 2 7例报告 )

目的　研究微导管可脱球囊技术治疗海绵窦瘘的临床意义。方法 :2 6例外伤性颈内动脉海绵窦瘘 (TCCF)患者和 1例大脑前动脉 (A1段 )动脉瘤破裂合并海绵窦瘘患者采用微导管可脱球囊技术进行栓塞治疗 ,以经颅多普勒 (TCD)进行复查 ,所有患者均随访 6月以上。结果 :2 2例CCF患者均成功栓塞瘘口并保持颈内动脉通畅 ,其中 2 0例为一次栓塞成功 ,2例因球囊过早泄漏而行 2次栓塞治疗。对 1例A1段动脉瘤破裂合并海绵窦瘘患者成功施行了双球囊动脉瘤颈孤立术。 4例行颈内动脉闭塞术。本组病例未发生严重并发症。结论 :微导管可脱球囊技术是对海绵窦瘘的一种微创、安全、有效的治疗方法。     

Willis覆膜支架治疗难治性外伤性颈动脉海绵窦瘘

目的 评价Willis覆膜支架血管内治疗难治性外伤性颈动脉海绵窦瘘(TCCF)的疗效,强调保留和重建颈内动脉(ICA)的重要性.方法 回顾性分析最近6年使用Willis覆膜支架治疗的12例外伤性TCCF,其中1例双侧瘘口.所有病例经可脱球囊治疗失败,术后1～60个月脑血管造影和临床随访评价其疗效.结果 小瘘口3个,多发...     

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.     

急症血管内栓塞治疗外伤性颈内动脉海绵窦瘘

目的探讨血管内栓塞治疗外伤性颈内动脉海绵窦瘘（TCCF）在紧急情况下的应用价值。方法TCCF297例，急诊血管内栓塞治疗36例中，其中严重鼻出血22例，大量流入皮质静脉9例，颅内出血3例，视力恶化3例，肢体功能障碍2例。全部病例采用可脱性球囊栓塞瘘口或闭塞颈内动脉，5例患者用可脱性球囊闭塞瘘口及颈内动脉后，采用弹簧圈保护性闭塞颈内动脉。结果36例中，1次性栓塞瘘口并颈内动脉通畅19例；1次性栓塞瘘口部及颈内动脉者17例。22例鼻出血者未再出血；3例颅内出血未再发生出血；3例视力恶化者2例视力恢复，1例明显提高；2例肢体功能障碍明显改善。结论血管内栓塞治疗TCCF是首选的治疗方法，急诊栓塞治疗对一些危及生命或可能导致严重后遗症的TCCF是必要、安全和有效的。     

可脱性球囊栓塞治疗Barrow A型颈动脉海绵窦瘘

目的探讨可脱性球囊栓塞治疗创伤性颈动脉海绵窦瘘的疗效及应用价值。资料与方法 18例Bar-row A型创伤性颈动脉海绵窦瘘,采用可脱性球囊经股动脉途径闭塞颈内动脉破口处或破口处患侧颈内动脉主干。结果术后18例颅内血管性杂音立即消失,16例闭塞了瘘口,颈内动脉主干保持通畅;2例同时闭塞了瘘口及颈内动脉主干。随访6～12个月,无复发。结论使用可脱性球囊栓塞治疗创伤性颈动脉海绵窦瘘创伤小、恢复快、安全可行,近期疗效确切。     

可脱球囊治疗外伤性颈内动脉海绵窦瘘

目的：研究外伤性颈内动脉海绵窦瘘的栓塞治疗。材料与方法：本文对5例外伤性颈内动脉海绵窦瘘患者施行了血管内介入栓塞术。所有患者均于手术前行Matas试验。结果：4例患者经可脱球囊栓塞术治疗，颈内动脉海绵瘘消失，颈内动脉保持通畅，颈内动脉海绵窦瘘的临床综合征于治疗后消失。1例由于瘘口较大，球囊不能完整闭塞瘘口，因该患者健侧颈内动脉代偿供应患侧的能力差，故无法栓塞患侧颈内动脉，栓塞术后该患者临床症状及体征有所改善但未能完全消除。结论：栓塞治疗对于外伤性预内动脉海绵窦瘘是一种有效治疗方法。     

创伤性颈动脉海绵窦瘘血管内治疗的护理

目的:探讨创伤性颈动脉海绵窦瘘(TCCF)血管内治疗中的护理。方法:本组37例TCCF,术前进行心理护理、侧支循环训练和眼部护理,术中配合医生操作,术后观察生命体征,早期发现过度灌注综合征。结果:37例均成功进行了血管内栓塞治疗,症状和体征消失。3例术后发生过度灌注综合征,由于发现及时均得到了有效缓解。结论:围手术期护理对于TCCF血管内治疗有重要意义。     

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.     

特殊类型颈动脉海绵窦瘘的血管内栓塞治疗

目的　探讨特殊类型颈动脉海绵窦瘘的血管内栓塞治疗的可行性及其价值。方法 :2 8例有外伤史的患者 ,采用Seldinger技术送入导管行全脑血管造影 ,观察侧支循环情况后 ,进行血管内栓塞治疗。结果 :双侧颈动脉海绵窦瘘 6例 ;单侧者为小瘘口 4例、多发瘘口者 2例 ,瘘口部合并骨折片者 11例 ,合并创伤性动脉瘤者 3例 ;栓塞后出现NPPB者 2例。血管内栓塞治疗中 ,闭塞瘘口保持颈内动脉通畅者 9例 ,闭塞瘘口同时闭塞颈内动脉者 19例。结论 :对于特殊类型颈动脉海绵窦瘘行血管内栓塞治疗是安全、有效的 ,应为首选的方法。对于不同病例应采取特例特办的原则 ,方可取得良好的治疗效果。     

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。     

外伤性颈动脉海绵窦瘘的综合影像评价

目的 评价各种影像学检查手段在诊断外伤性颈内动脉海绵窦瘘中的作用。资料与方法 回顾性分析15例颈动脉海绵窦瘘患者的各种影像学表现，其中CT、超声检查15例，脑血管造影12例，MRI检查3例。结果 颈内动脉海绵窦瘘CT表现为：眼球突出，眼上静脉扩张和海绵窦增大(15／15)，眶内软组织肿胀(9／15)和眼外肌肥厚(10／15)。MRI表现与CT大致相同，MRA可立体显示扩张的眼上静脉和瘘口(2／3)。脑血管造影于动脉期可见患侧海绵窦扩大显影并眼上静脉逆向充盈显影(12／12)，并可见瘘口显示(11／12)，压迫患侧颈总动脉，健侧颈内动脉造影可见患侧颈内动脉和海绵窦显影(9／12)。经颅多普勒超声检查可显示眼上静脉和海绵窦区的异常血流信号(15／15)，并能准确评价颈内动脉各段血流动力学改变。结论 各种影像学检查手段都有其优势和局限性，各种手段综合应用才能满足临床需要。     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

Objective

To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis.

Materials and Methods

For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography.

Results

Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention.

Conclusion

In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.     

Angiographic follow-up of traumatic carotid cavernous fistulas treated with endovascular stent graft placement

BACKGROUND AND PURPOSE: Endovascular treatment (EVT) of carotid cavernous fistulas (CCFs) is based on various techniques, mainly those using detachable balloons. Coronary covered stent grafts have been sporadically used in the intracranial arteries and only 2 traumatic CCFs have been reported in the literature; moreover, there is poor information about the long-term follow-up. We present 8 cases of CCFs treated by the placement of a covered stent, 5 of which have a 1-year clinical and angiographic follow-up. METHODS: Eight patients with posttraumatic CCF were treated by positioning a covered stent in the intracranial internal carotid artery (ICA) to occlude the fistula. They received periodic clinical and angiographic follow-up to evaluate the patency and the stability of clinical results. RESULTS: In all cases, the symptoms related to the CCF regressed after treatment and did not recur in the follow-up. Two patients presented residual filling of the CCF at the end of the procedure. The angiographic follow-up revealed in 6 patients of 7 a good patency of the ICA; in 1 patient, there was an ICA asymptomatic occlusion. One patient required transvenous coil occlusion of the cavernous sinus. CONCLUSION: When standard treatments fail, covered stent grafts can be used as a valid alternative in the treatment of CCFs, but more data are needed, especially in the long-term follow-up.     

创伤性颈动脉假性动脉瘤病因及诊治探讨

目的对创伤性颈动脉假性动脉瘤病因及血管内栓塞治疗进行探讨。方法对26例患者行数字减影血管造影术(DSA)检查明确诊断，同时行血管内栓塞治疗。5例采用微弹簧圈栓塞，19例采用可脱性球囊行假性动脉瘤开口处颈动脉闭塞，2例采用10％α-氰基丙烯酸正丁酯(NBCA)脑膜中动脉供支栓塞。结果20例栓塞后鼻腔出血停止，其中1例视力下降栓塞后1周视力好转。3例头痛3周后消失。3例颈部包块杂音消失、质软、无搏动。1例死亡。随访6-12个月无一例再次出血，颈部包块消失。结论血管内栓塞是治疗创伤性颈动脉假性动脉瘤有效的方法。     

外伤性颈内动脉海绵窦瘘的诊断及血管内栓塞治疗

目的探讨外伤性颈动脉海绵窦瘘(TCCF)的诊断方法和血管内球囊及可脱式弹簧圈(GDC)栓塞治疗的效果。方法回顾性研究48例患者共49个瘘口进行51次栓塞治疗,其中49次应用可脱式球囊进行栓塞,2次应用GDC进行栓塞。结果49个瘘口中31个闭塞瘘口同时颈内动脉保持通畅,2例患者2周后复发,应用球囊再次栓塞。18个闭塞患侧颈内动脉,1例患者出现暂时性肢体偏瘫。2例GDC栓塞闭塞瘘口并保持颈内动脉通畅。患者临床症状基本全部消失,部分术前视力下降者恢复不良。结论物理诊断和DSA脑血管造影对TCCF诊断最有意义。可脱式球囊栓塞是治疗TCCF的良好方式,辅助GDC栓塞总体上可以达到更好的结果。     

Treatment and follow-up of 22 unruptured wide-necked intracranial aneurysms of the internal carotid artery with Onyx HD 500

BACKGROUND AND PURPOSE: The purpose of this study was to demonstrate endovascular treatment of wide-necked aneurysms of the internal carotid artery with the liquid embolic agent Onyx HD 500. METHODS: Twenty-two wide-necked, large or giant aneurysms of the internal carotid artery (ICA) were treated in 22 patients with Onyx HD 500 (15 ophthalmic, 1 clinoid, and 6 cavernous aneurysms). Sixteen patients were asymptomatic, and mass effect of the aneuryms caused cranial nerve palsy in 6. Seven aneurysms showed regrowth after prior endovascular coiling. RESULTS: Postinterventional angiography demonstrated total occlusion in 18 aneurysms, and a small remnant was left in 4. Clinical and angiographic follow-up data are available in 19 patients (average follow-up, 13 months; range, 5-36 months). Total occlusion was demonstrated in 17 aneurysms (91%), and a partial recanalization was seen in 2. There were 2 ICA occlusions and 1 ICA stenosis. Clinical follow-up demonstrated a transient ischemic attack in 1 patient; 2 with cranial nerve palsy were unchanged, and 2 showed improved symptoms compared with the findings before treatment. The remaining 14 patients were clinically asymptomatic. There was no permanent severe morbidity and no mortality at follow-up. CONCLUSION: The endovascular treatment of wide-necked, large or giant ICA aneurysms with Onyx HD 500 is a treatment option in these selected cases. The benefit is a primary high and stable occlusion rate and good clinical outcome. ICA occlusion caused by Onyx migration in the parent artery is a typical problem, with a benign clinical course in this series.