Hayes Seth B, Johnson Jeremiah N, Most Zachary, Elhammady Mohamed Samy, Yavagal Dileep, Aziz-Sultan Mohammad Ali
Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida, USA.
J Neurointerv Surg. 2015 Jul;7(7):537-41. doi: 10.1136/neurintsurg-2014-011101. Epub 2014 May 26.
Intractable hemorrhage of the nasal or oropharyngeal cavities can be life threatening, and endovascular embolization is one of the few effective treatments for severe recurrent bleeds. Traditionally, embolic particles have been used for transarterial embolization.
To investigate the safety and efficacy of a less commonly performed treatment-namely, feeding artery occlusion with liquid embolic agents.
We retrospectively reviewed our neurointerventional database for patients who had undergone transarterial embolization for intractable nasal and oropharyngeal hemorrhage with Onyx, N-butyl-2 cyanoacrylate (n-BCA) glue, or both, at our institution over a 5-year period from 2008 to 2013.
Forty-six patients who underwent a total of 51 procedures met the inclusion criteria. Causes of hemorrhage included neoplasm n=35 (68.6%), trauma n=12 (23.5%), and idiopathic n=4 (7.9%). The bleeding was oropharyngeal in 66.7%, nasal in 29.4%, and 3.9% originated from both sites. Embolic agents used were n-BCA in 26 cases (51.0%), Onyx in 22 cases (43.1%), and both agents in three cases (5.9%). Mean total procedural time was 93.1 min (range 34-323 min), and mean fluoroscopy time was 39.1 min (10- 121 min). Mean follow-up time was 7.4 months (0.25-36 months). Five of the 46 patients (10.9%) required re-embolization and one (2.0%) rebled during the same hospital stay. One periprocedural cardiovascular adverse event occurred that was unrelated to the embolic agent used, but no other complications were seen.
Transarterial embolization with n-BCA or Onyx is a safe and effective treatment for patients with intractable nasal and oropharyngeal hemorrhage. Further prospective studies are warranted to confirm these findings.
鼻腔或口咽腔的难治性出血可能危及生命，而血管内栓塞是严重复发性出血的少数有效治疗方法之一。传统上，栓塞颗粒已用于经动脉栓塞。
探讨一种较少应用的治疗方法——即使用液体栓塞剂闭塞供血动脉的安全性和有效性。
我们回顾性分析了2008年至2013年期间在我院接受经动脉栓塞治疗难治性鼻腔和口咽出血的患者的神经介入数据库，这些患者使用了Onyx、N-丁基-2-氰基丙烯酸酯（n-BCA）胶水或两者。
46例患者共接受了51次手术，符合纳入标准。出血原因包括肿瘤35例（68.6%）、创伤12例（23.5%）和特发性4例（7.9%）。出血部位为口咽的占66.7%，鼻腔的占29.4%，3.9%来自两个部位。使用的栓塞剂为n-BCA 26例（51.0%）、Onyx 22例（43.1%）、两种栓塞剂联合使用3例（5.9%）。平均总手术时间为93.1分钟（范围34 - 323分钟），平均透视时间为39.1分钟（10 - 121分钟）。平均随访时间为7.4个月（0.25 - 36个月）。46例患者中有5例（10.9%）需要再次栓塞，1例（2.0%）在同一住院期间再次出血。发生了1例围手术期心血管不良事件，与所使用的栓塞剂无关，但未见其他并发症。
使用n-BCA或Onyx进行经动脉栓塞是治疗难治性鼻腔和口咽出血患者的一种安全有效的方法。需要进一步的前瞻性研究来证实这些发现。
