Multiple intracranial carotid injuries: pitfalls in diagnosis by angiography and principles of endovascular treatment.
Multiple intracranial carotid injuries: pitfalls in diagnosis by angiography and principles of endovascular treatment.
复制标题
多发性颅内颈动脉损伤：血管造影诊断的陷阱和血管内治疗的原则。
DOI：
10.1097/ta.0b013e31818ba44a
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Cheng‐Yen Chang
中科院分区：
文献类型：
--
作者：
C. Luo;M. Teng;F. Chang;Wan;Cheng‐Yen Chang
背景
头部外伤后同时发生颅内多发性颈动脉损伤（ICI）很少被转诊治疗，而且往往是致命的。本研究的目的是描述在诊断多发性ICI时的潜在血管造影陷阱，并报告15例34例ICI患者的血管内治疗原则。
方法
完成了对15名患者（8名男性和7名女性）的34例ICI的12年研究，患者接受了血管内治疗。其中外伤性颈动脉海绵窦瘘22例，外伤性颈动脉瘤6例，脑膜动静脉瘘5例，外伤性颈动脉闭塞1例。对32例脑缺血性脑损伤患者进行了经动脉血管内栓塞治疗。
结果
四个创伤性颈动脉瘤，四个脑膜动静脉瘘，和第二个洞的TCCF错过了早期发现的初步脑血管造影。在血管造影片中错过早期检测ICI的原因归因于发生在同侧颈内动脉区域的TCCF，由于忽视（n = 4），与附近的颈动脉和/或TCCF的瘘引流重叠（n = 2），盗血现象（n = 2）和ICI的潜伏期（n = 1）。成功封堵32例ICI。在随访中应用改良兰金量表，14例患者被评估为临床状态稳定。
结论
如果脑梗死发生在同一颈动脉，特别是与TCCF共存时，脑血管造影早期发现脑梗死可能比较困难。然而，一旦TCCF闭塞，应仔细检查栓塞后血管造影片，以发现潜在的相关ICI，并应立即进行血管内治疗。
BACKGROUND
Simultaneous multiple intracranial carotid injuries (ICIs) after head trauma are rarely referred for treatment and are often times fatal. The purpose of this study was to describe the potential angiographic pitfalls in diagnosis of multiple ICIs and to report the principles of endovascular management in 15 patients with 34 ICIs.
METHODS
A 12-year study of the 15 patients (8 men and 7 women) with 34 ICIs was completed, and patients were managed by endovascular treatment. Of the 34 ICIs, there were 22 traumatic carotid-cavernous fistulas (TCCFs), 6 traumatic carotid aneurysms, 5 meningeal arteriovenous fistulas, and 1 traumatic occlusion of carotid artery. Transarterial endovascular embolization was performed in 32 ICIs.
RESULTS
Four traumatic carotid aneurysms, four meningeal arteriovenous fistulas, and a second hole of the TCCF were missed in early detection by initial cerebral angiograms. The causes of missed early detection of ICIs in angiograms were attributed to occur with TCCFs in the ipsilateral internal carotid artery territory due to overlooking (n = 4), overlap with nearby carotid artery and/or fistula drains of TCCFs (n = 2), steal phenomenon (n = 2), and a latent period of ICI (n = 1). Successful occlusion of 32 ICIs was achieved. On the modified Rankin scale applied in follow-up, 14 patients were assessed as stable clinical status.
CONCLUSIONS
Early initial detection of ICIs in cerebral angiograms may be difficult if ICIs occur in the same carotid artery, particularly when they coexist with TCCF. However, as soon as TCCFs are occluded, postembolization angiograms should be scrutinized to find the potential associating ICIs, and endovascular management should be performed promptly.