Pang Peng-fei, Jiang Zai-bo, Zhou Bin, Li Zheng-ran, Huang Ming-sheng, Zhu Kang-shun, Guan Shou-hai, Chen Jun-wei, Shan Hong
Department of Radiology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
Zhonghua Yi Xue Za Zhi. 2012 Jun 5;92(21):1458-62.
To evaluate the feasibility and efficacy of endovascular treatment for different types of carotid cavernous fistula (CCF) via the approach of internal carotid artery (ICA) or inferior petrosal sinus (IPS).
From April 2005 to June 2010, 28 CCF patients underwent endovascular treatment at our institution. There were 13 males and 15 females with a mean age of 39 years (range: 21 - 71). According to the Barrow's classification, they were classified into type A (n = 21), type B (n = 2) and type D (n = 5). Patients of type A underwent detachable balloon embolization of ipsilateral cavernous sinus or stent-graft placement via the ICA approach. Patients of types B and D received detachable coil plus n-BCA (n-butyl-2-cyanoacrylate) embolization of ipsilateral cavernous sinus via the IPS approach. The technical results, complications and therapeutic outcomes were reviewed.
Detachable balloons (number: 1 - 4) were used in 16 patients of type A. Angiography at immediate postembolization showed a complete occlusion of fistula in 15 patients and a small residual fistula (< 20%) in 1 patient. Five patients of type A received stent-graft placement. One stent was placed in 4 patients and 2 stents in 1 patient. Complete fistula closures with preserved ICA were documented on immediate angiogram in 3 patients whereas a large residual flow (> 50%) persisted in 1. The fistula was completely occluded after 3 detachable balloons were deployed in affected cavernous sinus through a gap between stent and vascular wall. Both fistula and ICA were occluded in 1 patient after stenting. No cerebral infarction was observed due to the adequate collateral blood flow from contralateral ICA. Complete closures of affected cavernous sinus were achieved in 6 patients of types B and D while residual flow (< 50%) persisted in 1. The number of detachable coils for each embolization ranged from 3 to 8 (mean: 6.0). The volume of n-BCA mixture varied from 1.0 to 2.1 ml (mean: 1.3). The mean duration of n-BCA injection was 65 s (range: 45 - 90). Clinical symptoms were completely relieved in 26 patients. During the mean follow-up period of 30 months (range: 12 - 60), no recurrence of clinical symptoms was observed. No thrombosis or stenosis was found in the lumina of stents.
Detachable balloon embolization is the preferential treatment for direct CCF. Detachable coil plus n-BCA embolization of cavernous sinus via the IPS approach is an efficient and safe treatment for indirect CCF.
评估经颈内动脉（ICA）或岩下窦（IPS）途径对不同类型颈动脉海绵窦瘘（CCF）进行血管内治疗的可行性和疗效。
2005年4月至2010年6月，我院对28例CCF患者进行了血管内治疗。其中男性13例，女性15例，平均年龄39岁（范围：21 - 71岁）。根据巴罗分类法，将其分为A 型（n = 21）、B型（n = 2）和D型（n = 5）。A型患者经ICA途径行同侧海绵窦可脱性球囊栓塞术或支架植入术。B型和D型患者经IPS途径行同侧海绵窦可脱性弹簧圈联合n - BCA（正丁基 - 2 - 氰基丙烯酸酯）栓塞术。回顾技术结果、并发症及治疗效果。
16例A型患者使用了可脱性球囊（数量为1 - 4个）。栓塞后即刻血管造影显示15例患者瘘口完全闭塞，1例患者有小的残余瘘口（< 20%）。5例A型患者接受了支架植入术。4例患者植入1枚支架，1例患者植入2枚支架。即刻血管造影显示3例患者瘘口完全闭合且ICA保留，1例患者仍有大量残余血流（> 50%）。通过支架与血管壁之间的间隙在患侧海绵窦内再置入3个可脱性球囊后，瘘口完全闭塞。1例患者支架置入后瘘口和ICA均闭塞。由于对侧ICA有足够的侧支血流，未观察到脑梗死。6例B型和D型患者患侧海绵窦完全闭合，1例患者有残余血流（< 50%）。每次栓塞使用的可脱性弹簧圈数量为3 - 8个（平均：6.0个）。n - BCA混合剂的用量为1.0 - 2.1 ml（平均：1.3 ml）。n - BCA注射的平均时间为65秒（范围：45 - 90秒）。26例患者临床症状完全缓解。平均随访30个月（范围：12 - 60个月）期间，未观察到临床症状复发。支架腔内未发现血栓形成或狭窄。
可脱性球囊栓塞术是直接型CCF的首选治疗方法。经IPS途径行海绵窦可脱性弹簧圈联合n - BCA栓塞术是间接型CCF的一种有效、安全的治疗方法。
