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目的探讨覆膜支架对外伤性颈内动脉海绵窦瘘的血管内治疗效果。方法自2003年10月—2008年3月,采用覆膜支架治疗外伤性颈内动脉海绵窦瘘10例。结果10例外伤性颈内动脉海绵窦瘘的患者中,9例覆膜支架置入成功,其中在3例患者释放支架后,出现少许对比剂内漏,2例以更高的压力再次充胀球囊扩张后,内漏消失;另1例再扩后仍有内漏,置入第2枚覆膜支架后,内漏完全消除。10例中的另1例为患侧颈总动脉及颈内动脉过于迂曲,支架不能到位,在证实侧支循环代偿良好及球囊闭塞试验阴性后,给予可脱性球囊闭塞患侧颈内动脉。所有患者均无手术相关的并发症发生。DSA随访7例,原病变未显示,载瘘动脉通畅。结论对于外伤性颈内动脉海绵窦瘘,覆膜支架是有效的血管内治疗手段。覆膜支架的制作工艺仍有待发展和优化,使其适用于脑血管系统的不同部位应用。
Objective To investigate the endovascular treatment of traumatic carotid-cavernous fistula with stent-graft. Methods From October 2003 to March 2008, 10 cases of traumatic carotid cavernous fistula were treated with covered stent. Results Of the 10 traumatic carotid-cavernous fistulas, 9 of the stent-grafts were successfully implanted, with a slight leakage of contrast agent after stent release in 3 patients and 2 re-inflations with higher pressure After balloon dilatation, the internal leakage disappeared; the other one still had internal leakage after re-expansion. After the stent was placed in the second stent, the internal leakage was completely eliminated. Another case of 10 cases of ipsilateral common carotid artery and internal carotid artery too tortuous, the stent can not be put in place to confirm the collateral circulation compensatory good and balloon occlusion test was negative, given detachable balloon occlusion of the affected side of the neck artery. All patients had no surgery-related complications. DSA followed up in 7 cases, the original lesion did not show, fistula artery unobstructed. Conclusion For traumatic carotid-cavernous fistula, stent-graft is an effective endovascular treatment. The manufacturing process of the stent graft remains to be developed and optimized so that it can be applied to different parts of the cerebrovascular system.