Willis覆膜支架治疗两侧外伤性颈内动脉海绵窦瘘一例

病历资料患者男,38岁。受难于摩托车交通事故,导致颅底多发性骨折并出现两侧眼球突出、外翻1周。体检:神志清,语言流利,颈软,两侧眼球突出、外翻(右侧显著),球结膜充血,眼球活动受限,眶周闻及血管杂音,压颈后杂音消失,双侧瞳孔不等大,左为3.5 mm:右为4.5 mm,对光反射迟饨,双眼光感,余神经系统检查正常。DSA造影发现两侧外伤性直     

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...     

外伤性颈内动脉海绵窦瘘的血管内栓塞治疗

外伤性颈内动脉海绵窦瘘 (ＴＣＣＦ)是颅脑损伤的严重并发症 ,血管内栓塞治疗是首选的治疗方法 ,1995年 9月～2 0 0 0年 1月笔者用可脱性球囊栓塞治疗ＴＣＣＦ 15例 ,现报告如下。临　床　资　料1.一般资料 :男 10例 ,女 5例 ;年龄18～ 5 5岁 ,平均 2 8岁。均为交通伤 ,其中 8例为伤后 1周内入院 ,7例为伤后 1周以上入院。临床表现 :15例均有不同程度搏动性突眼 ,球结膜充血、水肿及颅内杂音 ,视力下降 12例 ,动眼神经麻痹 9例 ,外展神经麻痹 7例。 15例均行选择性脑血管造影 ,结果左侧ＴＣＣＦ 10例 ,右侧 5例 ,瘘口位于Ｃ3 ,4 交界处 2例 …     

带膜支架治疗外伤性颈内动脉海绵窦瘘一例

患者男，17岁，因车祸致头外伤3个月，闻及颅内杂音2个月，双侧眼球外突1个月入院。体检：双侧眼球外突，左眼球明显，结膜充皿，左眼内斜视、外展受限，左眼视力20cm数指，左侧视神经原发性萎缩。双侧眼球、眶部可闻及吹风样杂音，左侧明显，压迫左侧颈内动脉杂音减轻。颅脑CT检查未见异常。诊断：左侧外伤性颈内动脉海绵窦瘘（TCCF）。     

创伤性颈内动脉海绵窦瘘合并巨大动脉瘤及血管畸形一例报告

创伤性颈内动脉海绵窦瘘合并巨大动脉瘤及血管畸形,在颅脑损伤中较为少见。我院从1973—1988年收治198例重型颅脑损伤中,见到1例。报告如下: 患者,男,27岁。1982年12月曾被木棒击伤头部,伤后昏迷7天,当时左侧鼻腔、外耳道流血,同侧眼球外突。1983年9月在某医院行左侧颈动脉造影。诊断颈内动脉海绵窦瘘,行肌肉填塞放风筝手术,术后头痛、突眼无改善。84年10月9日饮酒以后,头痛突然加重,恶心呕吐,发烧,失语、呈嗜睡状态,于10月14日入院。检查:意识模糊,混合性失语Kernig氏征( ),左眼球明显外凸,伴有视神经萎缩,球结合膜及眼睑血管怒张、水肿,触诊有震颤,眼球及颞部可闻及连续性杂音,压迫患侧颈总动脉杂音减弱。右侧肢体肌力Ⅳ级,Babinski氏征( )。10月19日行左侧颈总动脉连续造影。见:颈内动脉粗直径9mm,同侧海绵窦内大量造影剂充盈,眼静脉粗直径10mm,眼动脉粗直径4mm,大脑中动脉分叉部以前有一直径3.5cm囊状动脉瘤,伴有同侧皮层及深部血管畸形,范围10×6×5.5cm,瘤蒂未能显示。(见图1-3)。10月21日突然出现意识丧失,双侧瞳孔散大,光反射消失,去脑强直,考虑为动脉瘤破裂,结扎颈总动脉。紧急开颅手术,见额颞骨有陈旧性骨折。硬膜下凝血块约40ml,脑内有凝血约70ml,大脑中动脉分叉     

外伤性双侧颈内动脉海绵窦瘘1例

1病例报告 患者男,38岁。因头部外伤2个月,头痛、左侧眼睑结膜外翻2周人院。患者2个月前骑自行车摔倒。额面部着地,当时无明显不适症状,头颅CT检查无明显异常。2周前突然出现左侧眼睑外翻,自觉左侧颅内轻微吹风样杂音,伴头痛。查体：左侧额面部陈旧性瘢痕,左侧颞前区听诊闻及吹风样杂音,     

覆膜支架--颅内动脉瘤血管内治疗的新策略

颅内动脉瘤常发生于青壮年年龄阶段的人群 ,其破裂病死率达 2 0 %～ 30 %。目前颅内动脉瘤的治疗主要有外科手术夹闭及血管内栓塞治疗 ,但对于颈内动脉和椎基动脉主干等特殊部位的动脉瘤 ,外科手术十分困难 ,疗效不令人满意。Iwamoto等[1] 发现经外科手术夹闭的动脉瘤仍有 4 %的病例在原动脉瘤附近发生再出血。颅内动脉瘤的血管内治疗以其创伤小、恢复快、疗效好等优点为由于各种原因不能手术或手术困难的患者提供了及时救治的选择方法。一、在颅内动脉瘤血管内治疗中支架的应用(一 )概况　颅内动脉瘤的血管内治疗方法主要有载瘤动脉闭塞、…     

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.     

带膜支架治疗颅内动脉瘤的临床分析

目的 探讨Jostent冠状动脉带膜支架对于难治性颅内动脉瘤的血管内治疗效果.方法 自2006-03-2008-04应用Jostent冠状动脉带膜支架治疗颅内难治性动脉瘤8例,其中颈内动脉瘤6例和椎动脉瘤2例.结果 在7例患者中带膜支架被成功释放于靶动脉,动脉瘤完全消除并保持载瘤动脉畅通,临床效果满意.在1例患者中,因血管迂曲,带膜支架无法到达指定位置.无手术相关并发症发生.DSA随访3例,原动脉瘤未显示,载瘤动脉畅通.结论 对于难治性颅内动脉瘤,带膜支架是有用的血管内治疗手段.     

可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘

目的 探讨外伤性颈内动脉海绵窦瘘（ＴＣＣＦ）的神经血管内介入治疗技术。材料与方法 应用法国Ｂａｌｔ公司的同轴可脱性球囊技术,在数字减影（ＤＳＡ）监视下,对１２例ＴＣＣＦ患者施行可脱性球囊栓塞治疗。结果 ９例患者成功地用球囊闭塞了颈内动脉瘘口,同时也保持了颈内动脉通畅;２例由于球囊进入瘘口困难,１例ＣＣＦ瘘在,改行闭塞瘘口同时闭塞了颈内动脉,术后除１例失明未恢复外,其余病例临床症状完全消失。结论 可     

颈内动脉海绵窦瘘血管内栓塞治疗的临床价值

目的　探讨颈内动脉海绵窦瘘的血管内栓塞治疗。方法　对 18例外伤性颈内动脉海绵窦瘘患者 ,全部经皮股动脉穿刺行全脑DSA检查确诊 ,用可脱球囊进行栓塞治疗。结果　 18例患者全部栓塞成功 ,其中 15例同时保持颈内动脉通畅 ,1例CCF瘘口较大 ,2例球囊进入瘘口困难 ,改行闭塞瘘口的同时栓塞同侧颈内动脉。术后除 1例患者眼睛失明未恢复外 ,其余病例临床症状及体征完全消失。结论　血管内栓塞技术是目前治疗CCF的最好方法 ,具有损伤小 ,安全性高 ,疗效可靠等特点     

Treatment of Esophagopleural Fistulas Using Covered Retrievable Expandable Metallic Stents

PurposeTo evaluate the clinical efficacy of placement of covered retrievable expandable metallic stents for esophagopleural fistulas (EPFs).Materials and MethodsDuring the period 1997–2013, nine patients with EPF were treated using covered retrievable expandable metallic stents. The underlying causes of EPF were esophageal carcinoma (n = 6), lung cancer (n = 2), and postoperative empyema for Boerhaave syndrome (n = 1).ResultsTechnical success was achieved in eight patients (88.9%). In one patient, incomplete EPF closure was due to incomplete stent expansion. Clinical success, defined as complete EPF closure within 7 days, was achieved in five patients (55.6%). Overall fistula persistence (n = 1) or reopening (n = 4) occurred in five patients (55.6%) 0–15 days after stent placement. The causes of reopening were due to the gap between the stent and the esophagus (n = 3) or stent migration (n = 1). For fistula persistence or reopening, additional interventional management, such as gastrostomy, stent removal, or stent reinsertion, was performed. Stent migration occurred as a complication in one patient with EPF from a benign cause secondary to postoperative empyema. In the eight patients who died during the follow-up period, the mean and median survival times were 78.8 days and 46 days, respectively.ConclusionsPlacement of a covered expandable metallic esophageal stent for the palliative treatment of EPF is technically feasible, although the rate of clinical success was poor secondary to fistula persistence or reopening. Fistula reopening was caused by the gap between the stent and the esophagus or by stent migration, and additional interventional treatment was useful to ensure enteral nutritional support.     

颈动脉海绵窦瘘的DSA评价及其分类

探讨数字减影血管造影对颈动脉海绵窦瘘评价的价值，并通过对其血管造影表现的分析，提出新的颈动脉海绵窦瘘的分类方法。材料和方法：56例颈动脉海绵窦瘘患者均行DSA检查，每例患者均行患侧超选择性颈内、外动脉造影，同时对本组病例进行分类。结果：56例颈动脉海绵窦瘘患者中，A型瘘38例，B型瘘4例，C型瘘10例，D型瘘2例，E型瘘2例。38例直接瘘患者中，1例瘘口位于海绵窦Ⅰ段，10例瘘口位于海绵窦Ⅱ段，4例瘘口位于海绵窦Ⅲ段，18例瘘口位于海绵窦Ⅳ段，5例瘘口位于海绵窦Ⅴ段。前交通代偿良好者33例，后交通代偿良好者39例，31例患者的前、后交通动脉均有代偿。56例颈动脉海绵窦瘘患者中，50例向眼静脉引流，47例向岩下窦引流，18例经皮层静脉引流，8例向后颅窝区引流。结论：1．数字减影血管造影可较好地显示颈动脉海绵窦瘘的位置和大小，同时可以有效地评价Willis环的功能，为颈动脉海绵窦瘘的治疗提供有价值的信息。2．颈动脉海绵窦瘘可分为5型，即A，B，C，D，E型瘘，其中E型瘘文献中未见类似报道。     

直接型颈动脉海绵窦瘘的血管内治疗

探讨血管内治疗对直接型颈动脉海绵窦瘘的价值。材料和方法：38例患者在治疗前均行脑血管造影检查，所有病例均采用经动脉途径，用可脱球囊导管进行栓塞治疗。结果：38例患者中有36例栓塞成功，其中34例患者瘘口完全闭塞。36例患者中有32例于栓塞后保留颈内动脉，4例行颈内动脉球囊闭塞术。术后36例患者的海绵窦综合症均有不同程度的好转。3例患者曾行经静脉途径可脱球囊栓塞治疗，但由于海绵窦内分隔的阻挡作用，球囊不能进入海绵窦及其瘘口附近而告失败。2例患者由于球囊早脱并移位于大脑中动脉分支血管内，导致患者发生失语和一侧肢体偏瘫。结论：血管内可脱球囊栓塞治疗直接型颈脉海绵窦瘘，其瘘口闭塞率高，死亡率低，是直接型颈动脉海绵窦瘘的首选治疗手段。     

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。     

Covered Stents for Treatment of Visceral Artery Aneurysms: A Multicenter Study

PurposeTo evaluate the safety and efficacy of covered stents for treatment of visceral artery aneurysms (VAA).MethodsThis multicenter retrospective study included patients with VAAs who were treated with covered stents between January 2015 and December 2020. A total of 65 patients (mean age, 58 years; range, 27–89 years) with 70 VAAs (60 true aneurysms [86%], 10 pseudoaneurysms [14%]) were included. Of the 65, 48 patients (74%) were asymptomatic. Patient demographics, endovascular treatments, and follow-up results were analyzed.ResultsAll patients received covered stents. The mean diameter was 2.9 cm (range, 1.0–7.6 cm) for symptomatic aneurysms and 2.5 cm (range, 1.0–9.0 cm) for asymptomatic aneurysms. Of the asymptomatic aneurysms, 89% had a saccular shape. The mean distance between the ostium of the artery in which the aneurysm occurred and the aneurysm was 3.9 cm (median, 3.0 cm; range, 0.5–10 cm). Additional coil embolization was used in 7 aneurysms (10%). During the procedure, 68 (97%) aneurysms were completely excluded, while 2 (3%) had a Type Ib endoleak. After a mean follow-up of 20 months (range, 1–75 months), all patients were asymptomatic. Four endoleaks were recorded and left for close observation. Four stents (7%) had mild restenosis, while the rest of the stents were patent.ConclusionsPlacement of covered stents in patients with VAAs excluded aneurysms and maintained artery patency.     

Aneurysms of Hemodialysis Access Grafts: Treatment with Covered Stents: A Report of Three Cases

Three patients with dialysis access graft shunts, having a symptomatic pseudoaneurysm and a hemodynamically significant stenosis at the anastomosis between the graft shunt and the subclavian vein, were treated with percutaneous transluminal angioplasty and insertion of a Wallstent. Pseudoaneurysms were excluded by percutaneous insertion of a Cragg Endo-Pro stent-graft with a diameter of 6 mm and a length of 6–10 cm. All three aneurysms were excluded successfully. In two patients, the stent-graft was punctured repeatedly during follow-up and the aneurysms recurred after 7 and 8 months, respectively. The patency of the dialysis shunt after stent-graft insertion was 8 (n= 1) and 9 months (n= 2). Due to the recurrence of the aneurysm (n= 2) or recurrent thrombosis (n= 1) the use of these shunts was discontinued.     

Covered Stents in the Treatment of Peripheral Arterial Aneurysms: Procedural Results and Midterm Follow-Up

Purpose: To evaluate initial and midterm results of percutaneous treatment of peripheral aneurysms using covered stents. Methods: Between June 1994 and December 1997 we used covered stents (EndoPro System or Passager) on 19 patients with peripheral aneurysms (7 iliac, 5 subclavian, 3 femoral, 3 popliteal, 1 carotid). Results: Successful aneurysm exclusion was achieved in 18 of 19 patients (95%). In the short term (<30 days), one patient died of puncture site hemorrhage complicated by myocardial infarction; two femoral stents were surgically removed because of leakage. At subsequent follow-up (mean 20 months) two further unrelated deaths occurred. At 1 year (intention-to-treat) the stent was patent in 13 of 19 patients (68%) and the aneurysm was excluded in 17 of 19 (89%). Conclusion: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural success. Continued exclusion of the aneurysms is achieved in a large proportion of patients but there is a relatively high rate of stent thrombosis.