Luo C-B, Teng M M H, Chang F-C, Chang C-Y
Department of Radiology, Taipei Veterans General Hospital, No. 201 Section 2 Shih-Pai Road, Beitou, Taipei 112, Taiwan, R.O.C.
AJNR Am J Neuroradiol. 2006 Aug;27(7):1535-40.
Transarterial detachable balloon embolization of direct carotid cavernous fistulas (DCCFs) has become an optimal treatment. In a few cases, the parent artery has to be sacrificed to achieve morphologic cure. We present our experience with transarterial balloon-assisted n-butyl-2-cyanoacrylate (n-BCA) embolization of DCCFs in which there was failure to achieve angiographic cure and preservation of parent arteries.
Of 141 patients with traumatic DCCFs who had been treated by transarterial embolization with occlusion of the fistula and parent artery preservation, 18 received transarterial balloon-assisted n-BCA embolization-6 for residual fistula after the balloons detached, 7 for recurrent fistula because of premature balloon deflation or migration, and 5 for repeated puncture of the detachable balloon by the bony fragment at the cavernous sinus. A total of 27 procedures were performed with an average 1.5 attempts per patient, and the volume of the n-BCA mixture varied from 0.5 to 2.3 mL with a mean of 0.83 mL.
All DCCFs were successfully occluded by the n-BCA mixture with preservation of parent arteries. One patient with a giant cavernous sinus varix had a fatal subarachnoid hemorrhage. One had a recurrence and was treated by internal carotid artery (ICA) occlusion. Five had asymptomatic pseudoaneurysms at the parent artery. There was no adhesion of the n-BCA mixture to the protective balloon or the microcatheter or n-BCA reflux into the parent arteries.
Transarterial balloon-assisted n-BCA embolization is a feasible, efficient, and safe treatment for DCCFs when angiographic cure and ICA preservation are not achieved by transarterial detachable balloon embolization.
经动脉可脱性球囊栓塞治疗直接型颈动脉海绵窦瘘（DCCF）已成为一种理想的治疗方法。在少数情况下，必须牺牲供血动脉才能实现形态学上的治愈。我们介绍了经动脉球囊辅助使用正丁基-2-氰基丙烯酸酯（n-BCA）栓塞DCCF的经验，该方法可在未能实现血管造影治愈且保留供血动脉的情况下进行。
141例经动脉栓塞治疗的创伤性DCCF患者中，瘘口闭塞且供血动脉得以保留，其中18例接受了经动脉球囊辅助n-BCA栓塞治疗，6例是因为球囊脱落后存在残余瘘，7例是由于球囊过早瘪陷或移位导致瘘复发，5例是因为海绵窦内的骨碎片反复刺破可脱性球囊。共进行了27次操作，每位患者平均尝试1.5次，n-BCA混合物的用量在0.5至2.3 mL之间，平均为0.83 mL。
所有DCCF均通过n-BCA混合物成功闭塞，供血动脉得以保留。1例巨大海绵窦静脉曲张患者发生致命性蛛网膜下腔出血。1例复发，接受了颈内动脉（ICA）闭塞治疗。5例在供血动脉处出现无症状假性动脉瘤。n-BCA混合物未与保护球囊或微导管粘连，也未出现n-BCA反流至供血动脉的情况。
当经动脉可脱性球囊栓塞无法实现血管造影治愈且保留ICA时，经动脉球囊辅助n-BCA栓塞是一种可行、有效且安全的DCCF治疗方法。
