覆膜支架治疗外伤性颈内动脉海绵窦瘘的临床分析

目的探讨覆膜支架对外伤性颈内动脉海绵窦瘘的血管内治疗效果。方法自2003年10月—2008年3月，采用覆膜支架治疗外伤性颈内动脉海绵窦瘘10例。结果10例外伤性颈内动脉海绵窦瘘的患者中，9例覆膜支架置入成功，其中在3例患者释放支架后，出现少许对比剂内漏，2例以更高的压力再次充胀球囊扩张后，内漏消失；另1例再扩后仍有内漏，置入第2枚覆膜支架后，内漏完全消除。10例中的另1例为患侧颈总动脉及颈内动脉过于迂曲，支架不能到位，在证实侧支循环代偿良好及球囊闭塞试验阴性后，给予可脱性球囊闭塞患侧颈内动脉。所有患者均无手术相关的并发症发生。DSA随访7例，原病变未显示，载瘘动脉通畅。结论对于外伤性颈内动脉海绵窦瘘，覆膜支架是有效的血管内治疗手段。覆膜支架的制作工艺仍有待发展和优化，使其适用于脑血管系统的不同部位应用。

Covered stents for treatment of traumatic carotid cavernous fistulas: a clinical analysis

Objective To investigate the therapeutic effect of the covered stents on traumatic carotid cavernous fistulas. Methods 10 patients with traumatic carotid cavernous fistulas were treated with placement of covered stents from October 2003 to March 2008. Results The covered stents were deployed successfully in 9 patients, Three of them had few contrast agent endoleaks after stent placement. The endoleaks disappeared in 2 patients after redilatation of balloon with higher pressure. Another patient still had endoleak after the redilatation, and it disappeared completely after the second covered stent was deployed. The stents could not reach the desired site in one case because the ipsilateral common carotid artery and internal carotid artery were too tortuous, The ipsilateral internal carotid artery was occluded with detachable balloons after confirmed that the compensative collateral circulation was sufficient and balloon occlusion test （BOT） was negative. No procedure-related complications occurred in all patients. Seven patients were followed up with digital subtraction angiography （DSA）, the original lesions were not dis- played, and there was no intra-stent obstruction. Conclusion The covered stent is an effective endovascular therapeutic intervention for traumatic carotid cavernous fistulas. Its manufacturing technique still needs to be improved and optimized so that to make it applicable to different cerebrovascular conditions.