Endovascular treatment strategy for direct carotid-cavernous fistulas resulting from rupture of intracavernous carotid aneurysms.
Endovascular treatment strategy for direct carotid-cavernous fistulas resulting from rupture of intracavernous carotid aneurysms.
复制标题
颈动脉海绵体内动脉瘤破裂导致直接颈动脉海绵窦瘘的血管内治疗策略。
DOI：
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
J. Yoshida
中科院分区：
文献类型：
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作者：
N. Kobayashi;S. Miyachi;M. Negoro;O. Suzuki;K. Hattori;T. Kojima;J. Yoshida
背景和目的
已报告的动脉瘤性颈动脉海绵窦瘘（CCF）的治疗和结局与被认为是海绵窦内动脉瘤症状的病例混合。然而，囊性CCF的临床特征与硬脑膜动静脉瘘不同，需要与创伤性CCF相似的治疗策略。我们评价了在海绵窦内动脉瘤破裂引起的自发性CCF的治疗中放置可脱性球囊的经验。
方法
1995年至2001年，我们的机构治疗了6例自发性直接CCF患者（1例男性，5例女性;平均年龄64.7岁）。所有患者均出现突发性眼部症状，包括眼球突出、结膜充血、球结膜水肿和眼球运动麻痹。5例患者使用可分离乳胶球囊作为栓塞材料，1例患者经动脉用弹簧圈填塞海绵窦。
结果
所有6例患者均通过经动脉栓塞成功治疗，症状在一周内改善。
结论
尽管使用经静脉入路和/或可脱性弹簧圈的其他技术也可能有用，但使用可脱性球囊栓塞应该是立即闭塞瘘的安全有效方法。
BACKGROUND AND PURPOSE
Reported treatments and outcomes in aneurysmal carotid-cavernous fistulas (CCFs) have been admixed with those of cases considered to be symptomatic of intracavernous aneurysm. However, aneurysmal CCFs have clinical features distinct from those of dural arteriovenous fistulas, and treatment strategies similar to those of traumatic CCF are required. We evaluated our experience in placing detachable balloons in the management of spontaneous CCFs due to rupture of an intracavernous aneurysm.
METHODS
Six patients (one man, five women; mean age, 64.7 years) were treated for spontaneous direct CCF at our institution between 1995 and 2001. All patients presented with sudden ocular symptoms including exophthalmos, conjunctival injection, chemosis, and ocular motor palsies. Detachable latex balloons were used as the embolic material in five patients, and in one patient the cavernous sinus was packed transarterially with coils.
RESULTS
All six patients were successfully treated by means of transarterial embolization, and symptoms improved within a week.
CONCLUSION
Although other techniques using a transvenous approach and/or detachable coils may also be useful, embolization with detachable balloons should be a safe and effective method to immediately occlude the fistula.