Cares H L, Roberson G H, Grand W, Hopkins L N
J Neurosurg. 1978 Jul;49(1):146-9. doi: 10.3171/jns.1978.49.1.0146.
The authors report a technique to precisely localize a fistulous opening in the carotid artery. The patient is heparinized and a Prolo catheter is introduced into the internal carotid artery and inflated distal to the approximate site of the fistula. Heparinization allows the balloon to be inflated long enough to obtain and analyze high-quality angiography film without fear of thromboembolism generated by the temporary balloon occlusion. Contrast material injected through the Prolo catheter proximal to the balloon reveals a small segment of cavernous carotid artery between the inflated balloon distally and the fistula proximally. The venous structures are now only faintly opacified and cannot obscure the morbid anatomy of the exact fistulous tear in the carotid artery. If the balloon is placed exactly opposite to the site of the fistula, a standing, stagnant column of dye forms a cast of the cavernous, petrous, and cervical carotid artery. Once the fistula is localized with this method, it may be obliterated by any therapeutic means preferred. If the Prolo catheter is used for intraluminal occlusion, then a transfemoral contralateral carotid angiogram is done before the heparin is reversed to confirm that the balloon has not been placed proxial to the fistula.
作者报告了一种精确定位颈动脉瘘口的技术。患者接受肝素化处理，将普洛导管插入颈内动脉，并在瘘口大致位置的远端充气。肝素化使得球囊能够充气足够长的时间以获取和分析高质量的血管造影胶片，而无需担心临时球囊闭塞产生的血栓栓塞。通过在球囊近端的普洛导管注入造影剂，可显示在远端充气的球囊与近端瘘口之间的一小段海绵窦段颈动脉。此时静脉结构仅轻微显影，不会掩盖颈动脉确切瘘口撕裂处的病变解剖结构。如果球囊放置在与瘘口完全相对的位置，一个静止不动的造影剂柱会形成海绵窦段、岩骨段和颈段颈动脉的铸型。一旦用这种方法定位了瘘口，就可以通过任何首选的治疗手段将其闭塞。如果使用普洛导管进行腔内闭塞，那么在肝素逆转之前进行经股对侧颈动脉血管造影，以确认球囊未放置在瘘口近端。
