Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, China.
Neurosurgery. 2012 Dec;71(2 Suppl Operative):ons269-73; discussion ons273. doi: 10.1227/NEU.0b013e3182684b70.
In transarterial embolization of anterior cranial fossa and tentorial dural arteriovenous fistula (DAVF), acute angulation of the feeding artery off the internal carotid artery (ICA) may render stable distal catheterization and, therefore, successful transarterial treatment difficult. In some anatomic dispositions, following selection of the feeding artery, subsequent forward force may lead to prolapse of the microcatheter into the ICA rather than advancing it into either the ophthalmic artery or the meningohypophyseal trunk.
We describe a technique that facilitates stable positioning of the microcatheter by using a nondetachable balloon to temporally block the ICA distal to the feeding artery to redirect the catheter into the feeder and to prevent the microcatheter from protruding into the parent artery.
In 8 cases where routine superselective microcatheterization failed, a balloon was used to block the ICA distal to the feeding artery in an attempt to facilitate superselective microcatheterization. The balloon was inflated following selection of the feeding vessel with the microcatheter and was kept inflated while advancing the catheter.
: Distal stable microcatheter positions could be obtained in all cases, which enabled us to treat the respective DAVFs with a liquid embolic agent. All 8 cases were angiographically cured with penetration of the liquid embolic agent from the distal artery to the proximal vein, and no procedure-related complications occurred.
The described technique may be a helpful adjunct to gain stable distal microcatheter positions during the transarterial treatment of DAVF.
在前颅窝和天幕硬脑膜动静脉瘘（DAVF）的经动脉栓塞中，颈内动脉（ICA）发出的供血动脉的急性成角可能会使远端导管稳定，并因此使经动脉治疗成功变得困难。在某些解剖位置中，选择供血动脉后，随后的向前力可能导致微导管突入 ICA 而不是将其推进到眼动脉或脑膜垂体干中。
我们描述了一种技术，该技术通过使用不可拆卸的球囊暂时阻塞 ICA 以重新引导导管进入供血动脉并防止微导管突入母动脉，从而便于微导管稳定定位。
在 8 例常规超选择性微导管插入术失败的病例中，使用球囊阻塞 ICA 以尝试在供血动脉远端进行超选择性微导管插入术。在用微导管选择供血血管后，对球囊进行充气，并在推进导管时保持充气状态。
所有病例均获得了稳定的远端微导管位置，使我们能够用液体栓塞剂治疗相应的 DAVF。所有 8 例均通过从远端动脉到近端静脉的液体栓塞剂渗透达到血管造影治愈，并且没有发生与手术相关的并发症。
所描述的技术可能有助于在经动脉治疗 DAVF 期间获得稳定的远端微导管位置。
