Alatzides Georgios Luca, Opitz Marcel, Li Yan, Goericke Sophia, Oppong Marvin Darkwah, Frank Benedikt, Eckstein Anja Katrin, Köhrmann Martin, Wrede Karsten, Forsting Michael, Wanke Isabel, Deuschl Cornelius
Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany.
Department of Neurosurgery and Spine Surgery, Essen University Hospital, Essen, Germany.
Front Neurol. 2023 Feb 9;14:1123139. doi: 10.3389/fneur.2023.1123139. eCollection 2023.
Multimodal endovascular therapy (EVT) of carotid cavernous fistula (CCF) with different approaches and a variety of available embolization material enable high occlusion rates with good clinical and functional outcome but until now there is still little evidence available. This retrospective single-center study aims to evaluate EVT of CCF with different neuroendovascular techniques regarding occlusion rates, complications and outcomes.
From 2001 to 2021 59 patients with CCF were treated at our tertiary university hospital. Patient records and all imaging data including angiograms were reviewed for demographic and epidemiological data, symptoms, fistula type, number of EVTs, complications of EVT, type of embolic materials, occlusion rates and recurrences.
Etiology of the CCF were spontaneous (41/59, 69.5%) post-traumatic (13/59, 22%) and ruptured cavernous aneurysms (5/59, 8.5%). Endovascular therapy was completed in one session in 74.6% (44/59). Transvenous access was most frequent (55.9% 33/59) followed by transarterial catheterization in 33.9% (20/59) and a combination of both (6/59, 10.2%). Exclusively coils were used in 45.8% (27/59), a combination of ethylene vinyl alcohol (EVOH) copolymer (Onyx) and coils in 42.4% (25/59). Complete obliteration was achieved in 96.6% of patients (57/59) with an intraprocedural-related complication rate of 5.1% (3/59) and no mortality.
Endovascular therapy of CCF has been shown to be safe and effective with high cure rates and low rates of intraprocedural complications and morbidity even in complex scenarios.
采用不同入路及多种可用栓塞材料对海绵窦瘘（CCF）进行多模态血管内治疗（EVT），可实现较高的闭塞率，并获得良好的临床及功能预后，但目前相关证据仍然较少。这项回顾性单中心研究旨在评估采用不同神经血管内技术对CCF进行EVT治疗的闭塞率、并发症及预后情况。
2001年至2021年期间，我们三级大学医院共治疗了59例CCF患者。对患者记录及所有影像数据（包括血管造影）进行回顾，以获取人口统计学和流行病学数据、症状、瘘管类型、EVT次数、EVT并发症、栓塞材料类型、闭塞率及复发情况。
CCF的病因包括自发性（41/59，69.5%）、创伤后（13/59，22%）及海绵状动脉瘤破裂（5/59，8.5%）。74.6%（44/59）的患者在一次治疗中完成了血管内治疗。经静脉入路最为常见（55.9%，33/59），其次是经动脉导管插入术，占33.9%（20/59），两者联合使用的占10.2%（6/59）。45.8%（27/59）的患者仅使用了弹簧圈，42.4%（25/59）的患者使用了乙烯-乙烯醇（EVOH）共聚物（Onyx）与弹簧圈的组合。96.6%（57/59）的患者实现了完全闭塞，术中相关并发症发生率为5.1%（3/59），无死亡病例。
即使在复杂情况下，CCF的血管内治疗也已被证明是安全有效的，治愈率高，术中并发症及发病率低。
