Niu Yin, Li Lin, Tang Jun, Zhu Gang, Chen Zhi
Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
Interv Neuroradiol. 2016 Apr;22(2):201-5. doi: 10.1177/1591019915609779. Epub 2015 Nov 18.
Multiple endovascular management of direct carotid cavernous fistula (CCF) has been widely accepted as a treatment option. Embolization of the fistula with detachable balloons or thrombogenic coil-based occlusion has been the main choice to treat direct CCF, with good safety and efficacy. This study investigated the safety and efficacy of embolization of direct CCF with the novel double-balloon technique. A retrospective review of a prospective database on cerebral vascular disease was performed. We identified a total of five patients presenting with high-flow direct CCF. All patients were managed with transarterial embolization with the novel double-balloon technique. Three of the five patients were treated with two detachable balloons, and a completely occluded fistula with preservation of the internal carotid artery was achieved. Of the remaining two patients treated with more detachable balloons, one patient achieved a perfect outcome and the other one suffered from recurrent fistula due to balloon migration 3 weeks after embolization. During a follow-up period of 12-18 months, no symptoms reoccurred in any patient. Thus, the double-balloon treatment may be a promising method for CCF complete occlusion. This novel technique may bring more benefits in the following two cases: 1). A single inflated detachable balloon fails to completely occlude the CCF, which causing the next balloon can not pass into the fistula. 2). A giant CCF needs more balloons for fistula embolization.
直接型颈内动脉海绵窦瘘（CCF）的多种血管内治疗方法已被广泛认可为一种治疗选择。使用可脱性球囊或基于致血栓形成的线圈进行瘘口栓塞一直是治疗直接型CCF的主要选择，具有良好的安全性和有效性。本研究探讨了采用新型双球囊技术栓塞直接型CCF的安全性和有效性。对一个关于脑血管疾病的前瞻性数据库进行了回顾性研究。我们共确定了5例高流量直接型CCF患者。所有患者均采用新型双球囊技术经动脉栓塞治疗。5例患者中有3例使用了2个可脱性球囊进行治疗，实现了瘘口完全闭塞且保留了颈内动脉。其余2例使用了更多可脱性球囊治疗的患者中，1例取得了完美的治疗效果，另1例在栓塞后3周因球囊移位出现了复发性瘘口。在12至18个月的随访期内，所有患者均未出现症状复发。因此，双球囊治疗可能是一种有前景的CCF完全闭塞方法。这种新技术在以下两种情况下可能会带来更多益处：1）单个充气的可脱性球囊未能完全闭塞CCF，导致下一个球囊无法进入瘘口。2）巨大型CCF需要更多球囊进行瘘口栓塞。
