Nesbit G M, Barnwell S L
Dotter Interventional Institute and the Department of Radiology, Oregon Health Sciences University Portland, 97201, USA.
AJNR Am J Neuroradiol. 1998 Sep;19(8):1565-9.
High-flow arteriovenous fistulas (AVFs) are commonly treated by using an endovascular approach with a variety of materials. The use of a Guglielmi electrolytically detachable coil (GDC) provides the ability to reposition or remove the coil if its position is not optimal and may minimize the risk of coil migration or distal embolization. This study reports our experience in using these coils alone or in combination with other materials in the treatment of intracranial and cervical high-flow fistulas.
Twelve patients with AVFs were treated with GDCs via the transvenous or transarterial-transfistulous routes. The six dural AVFs treated transvenously were also treated transarterially, and the GDCs were combined with fibered coils in three of these patients and in two other patients with pial AVFs. All patients have been clinically followed up for 12 to 48 months (mean, 28 months).
Angiographic obliteration was obtained in all 12 patients. The fistulas have remained closed in 11 patients, as ascertained by angiographic confirmation in two patients and by clinical examination in nine patients. The one patient with recurrence experienced neurologic improvement and refused further treatment. GDCs required repositioning before detachment in seven patients, and no migration occurred after detachment.
GDCs are useful for the treatment of high-flow AVFs. They afford more control in the placement of coils and may provide an anchoring point for more thrombogenic materials.
高流量动静脉瘘（AVF）通常采用血管内入路并使用多种材料进行治疗。使用 Guglielmi 电解可脱卸弹簧圈（GDC），若其位置不理想，能够重新定位或取出弹簧圈，并且可将弹簧圈移位或远端栓塞的风险降至最低。本研究报告了我们单独使用这些弹簧圈或与其他材料联合使用治疗颅内和颈部高流量瘘的经验。
12 例 AVF 患者通过经静脉或经动脉-经瘘途径接受 GDC 治疗。经静脉治疗的 6 例硬脑膜 AVF 患者也接受了经动脉治疗，其中 3 例患者的 GDC 与纤维弹簧圈联合使用，另外 2 例软脑膜 AVF 患者也采用了这种联合方式。所有患者均接受了 12 至 48 个月（平均 28 个月）的临床随访。
12 例患者均实现了血管造影闭塞。11 例患者的瘘保持闭合状态，其中 2 例经血管造影证实，9 例经临床检查证实。1 例复发患者神经功能有所改善，拒绝进一步治疗。7 例患者在弹簧圈解脱前需要重新定位，解脱后未发生移位。
GDC 对高流量 AVF 的治疗有效。它们在弹簧圈放置方面提供了更多的可控性，并且可能为更多促血栓形成材料提供一个锚定部位。
