Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil.
J Neurointerv Surg. 2018 May;10(5):461-462. doi: 10.1136/neurintsurg-2017-013318. Epub 2017 Aug 19.
Transvenous embolization is the standard treatment for dural carotid cavernous fistulas (DCCF). Although various embolic materials have been used, the best embolic material for the treatment of DCCF is still unknown.
To assess the safety and efficacy of different embolic materials used for the endovascular treatment of DCCF.
A retrospective data analysis of a consecutive series of 62 patients presenting DCCF was performed. Clinical and radiological data from patients were assessed, and the embolic material used-coils or liquids-were compared between two groups of patients.
Complete angiographic occlusion of DCCF after treatment was achieved in 83.9% of the patients (52/62). We found a higher rate of complete occlusion of DCCF when liquids were associated with coils than with coils alone (96.5% vs 71.8%, p=0.01), and no differences in complication rates or clinical outcomes were seen between the two groups. At the 6-month follow-up, we found a higher rate of improvement in ocular symptoms compared with cranial nerve palsy improvement (94.7% vs 77.7%, p=0.02). Two patients (3.2%) had treatment-related complications without clinical symptoms.
In this study, in comparison with the use of coils alone, the association of transvenous embolization with liquid embolic agents for DCCF treatment resulted in higher rates of complete occlusion without increasing complication rates. The clinical outcome at the 6-month follow-up showed significant improvement in ocular symptoms over cranial nerve palsy regression, which was independent of the embolic agent chosen for treatment.
经静脉栓塞是治疗硬脑膜颈动脉海绵窦瘘（DCCF）的标准治疗方法。尽管已经使用了各种栓塞材料，但治疗 DCCF 的最佳栓塞材料仍不清楚。
评估用于治疗 DCCF 的不同栓塞材料的安全性和有效性。
对连续就诊的 62 例 DCCF 患者进行回顾性数据分析。评估患者的临床和影像学数据，并比较两组患者使用的栓塞材料（线圈或液体）。
62 例患者中有 83.9%（52/62）在治疗后实现了 DCCF 的完全血管闭塞。我们发现，与单独使用线圈相比，液体联合线圈可提高 DCCF 的完全闭塞率（96.5%对 71.8%，p=0.01），且两组的并发症发生率或临床结局无差异。在 6 个月的随访中，我们发现眼部症状的改善率高于颅神经麻痹的改善率（94.7%对 77.7%，p=0.02）。有 2 例患者（3.2%）出现与治疗相关的并发症，无临床症状。
在这项研究中，与单独使用线圈相比，经静脉栓塞联合液体栓塞剂治疗 DCCF 可提高完全闭塞率，而不增加并发症发生率。6 个月随访时的临床结果显示，眼部症状的改善明显优于颅神经麻痹的恢复，这与所选择的治疗栓塞剂无关。
