Placement of Covered Stents for the Treatment of Direct Carotid Cavernous Fistulas
Placement of Covered Stents for the Treatment of Direct Carotid Cavernous Fistulas
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DOI：
10.3174/ajnr.a1583
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发表时间：
2009-08-01
影响因子：
3.5
通讯作者：
Mao, B.
中科院分区：
文献类型：
--
作者：
Wang, C.;Xie, X.;Mao, B.
背景和目的：血管内可脱性球囊闭塞和弹簧圈闭塞是治疗直接颈动脉海绵窦瘘（DCCF）的2种成熟选择。近年来，覆膜支架已应用于治疗神经血管病变，如动脉瘤、假性动脉瘤、动脉夹层和DCCF。本研究的目的是探讨覆膜支架治疗DCCFs.MATERIALS和METHODS的临床疗效：10个连续的患者进行了覆膜支架放置失败后，可脱性球囊闭塞治疗DCCF。结果：支架置入术后5 ~ 48个月（平均18.2个月）随访，除1例患者外，其余患者支架置入术均获得成功。在该患者中，由于Jostent GraftMaster冠状动脉覆膜支架的刚性和颈内动脉（伊卡）的迂曲解剖结构，多次尝试后支架置入失败。6例患者在支架展开后立即实现了瘘的完全隔绝。3例患者观察到内漏。支架再扩张避免了2例患者的内漏;在这2例患者中的1例患者中，之前改善的症状在第二天早上复发，用可解脱球囊闭塞了同侧伊卡。支架置入后，在大多数患者中观察到伊卡痉挛;然而，不需要血管成形术。治疗后所有患者的症状均改善，无血栓栓塞事件。随访脑血管造影显示完全排除所有DCCF和支架通畅，没有intrastent狭窄的8例谁已成功部署stents.CONCLUSIONS：虽然需要更大的样本和扩大的后续行动，我们的系列表明，覆膜支架可用于治疗DCCF症状缓解。
BACKGROUND AND PURPOSE: Endovascular detachable balloon occlusion and coil occlusion are 2 well-established options for the treatment of direct carotid cavernous fistulas (DCCFs). In recent years, covered stents have been applied in the treatment of neurovascular pathologies such as aneurysms, pseudoaneurysms, arterial dissections, and DCCFs. The purpose of this study was to investigate the clinical efficacy of covered stents for the treatment of DCCFs.MATERIALS AND METHODS: Ten consecutive patients underwent covered-stent placement after failure of detachable balloon occlusion for the treatment of their DCCFs. Clinical and angiographic follow-up ranged from 5 to 48 months (mean, 18.2 months) after stent placement.RESULTS: Stent placement was technically successful in all except 1 patient. In this patient, stent placement failed after multiple attempts because of rigidity of the Jostent GraftMaster Coronary Stent Graft and the tortuous anatomy of the internal carotid artery (ICA). Complete exclusion of the fistula was achieved in 6 patients immediately after stent deployment. Endoleak was observed in 3 patients. Re-dilation of the stent avoided the endoleak in 2 patients; in I of these 2 patients, formerly improved symptoms recurred the next morning and the ipsilateral ICA was occluded with detachable balloons. Spasm of the ICA was observed in most of the patients after stent placement; however, angioplasty was not required. Symptoms improved in all patients after treatment, without thromboembolic events. Follow-up cerebral angiography showed complete exclusion of all DCCFs and stent patency without intrastent stenosis in the 8 patients who had successful deployment of the stent.CONCLUSIONS: Although a larger sample and expanded follow-up are needed, our series shows that covered stents can be used in the treatment of DCCFs with symptomatic relief.