Transarterial platinum coil embolization of carotid-cavernous fistulas.
Transarterial platinum coil embolization of carotid-cavernous fistulas.
复制标题
经动脉铂弹簧圈栓塞治疗颈动脉海绵窦瘘。
DOI：
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发表时间：
1991
期刊：
影响因子：
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通讯作者：
G. Hieshima
中科院分区：
文献类型：
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作者：
V. Halbach;R. Higashida;S. Barnwell;C. Dowd;G. Hieshima
在过去10年中，我们的神经介入部对症状性颈动脉-海绵窦瘘进行了227次栓塞术，其中5次是通过动脉途径在海绵窦内放置铂金弹簧圈。在4名患者中，先前的经动脉球囊手术未能产生瘘管闭合。在第五例Ehler-Danlos综合征患者中，先前的经静脉栓塞术尝试失败。在3例患者中，颈动脉-海绵窦瘘完全闭合，保留了载瘤动脉。在最早接受治疗的一名患者中，铂金线圈的一部分通过瘘管投射到载瘤动脉。为了消除血栓形成和远端栓塞术的风险，进行了颈内动脉闭塞手术，并无损伤地耐受。在最后一例患者中，前引流管闭合，但并发铂金线圈远端移位，眼部症状一过性加重。铂金弹簧圈试图封堵残留的皮质引流不成功；因此，使用气囊封堵残留的小瘘管。对于其他栓塞术无法成功闭合的症状性颈动脉海绵窦瘘，经动脉铂圈栓塞术是一种替代治疗方法。更短、更易血栓形成、可拆卸或可回收的线圈的开发可能会使这项技术在未来更有前途。
Of the 227 embolization procedures performed by our neurointerventional section for symptomatic carotid-cavernous fistulas over the past 10 years, five involved placement of platinum coils in the cavernous sinus from a transarterial route. In four patients, prior transarterial balloon procedures had failed to produce fistula closure. In the fifth patient, with Ehlers-Danlos syndrome, a prior transvenous embolization attempt was unsuccessful. In three patients, complete closure of the carotid-cavernous fistula was achieved with preservation of the parent artery. In one patient, the earliest treated, a portion of a platinum coil projected through the fistula into the parent artery. To eliminate the risk of clot formation and distal embolization, internal carotid occlusion was performed and tolerated without deficits. In the last patient, closure of the anterior drainage was achieved, but complicated by distal migration of the platinum coils with transient aggravation of ocular symptoms. Attempts to occlude the remaining cortical drainage were unsuccessful with platinum coils; therefore, a balloon was used to obliterate the small remaining fistula. Transarterial platinum coil embolization is an alternative treatment for symptomatic carotid-cavernous fistulas that cannot be closed successfully by other embolization techniques. The development of shorter, more thrombogenic, detachable or retrievable coils may make this technique more promising in the future.