CAJ | 학술논문

目的颈内动脉入路及岩下窦入路治疗不同类型颈动脉海绵窦瘘(CCF)的临床疗效分析.方法 2005年4月至2010年6月中山大学附属第三医院放射科诊治的28例CCF患者,男13例、女15例,年龄21～71岁,平均39岁.根据Barrow分型,A型21例,B型2例,D型5例.A型患者接受颈内动脉入路可脱球囊栓塞或覆膜支架治疗.B型和D型患者接受岩下窭入路弹簧圈联合氰基丙烯酸正丁酯( n-BCA)栓塞治疗.回顾性分析手术成功率,并发症及临床症状缓解情况.结果 21例A型患者中,16例接受可脱球囊栓塞(球囊1～4个),术后即时造影证实瘘口完全闭塞消失15例,残留小瘘口1例(＜20％).5例接受覆膜支架(直径4～5 mm,长度12～19mm)治疗.置入2枚支架1例,1枚支架4例.瘘口完全闭塞3例.1例残留较大瘘口(＞50％),经支架与血管壁的间隙于海绵窦置入3个可脱球囊后瘘口完全闭塞.支架置入后颈内动脉及瘘口完全闭塞1例.由于对侧血流代偿良好,患者未发生脑梗死.7例B型和D型患者中,完全闭塞患侧海绵窦6例,残留瘘口1例(＜50％).使用弹簧圈3～8个(平均6个),超液化碘油与n-BCA混合液的体积1.0～2.1 ml(平均1.3ml),注射时间45 ～90 s(平均65 s).临床症状完全缓解26例,随访12 ～60个月,平均30个月.随访期间无复发病例,颈动脉覆膜支架内未发生狭窄、闭塞.结论直接型CCF首选可脱球囊栓塞.岩下窦入路弹簧圈联合n-BCA栓塞是间接型CCF安全、有效的治疗方案.
목적 경내동맥입로급암하두입로치료불동류형경동맥해면두루(CCF)적림상료효분석.방법 2005년4월지2010년6월중산대학부속제삼의원방사과진치적28례CCF환자,남13례、녀15례,년령21～71세,평균39세.근거Barrow분형,A형21례,B형2례,D형5례.A형환자접수경내동맥입로가탈구낭전새혹복막지가치료.B형화D형환자접수암하구입로탄황권연합청기병희산정정지( n-BCA)전새치료.회고성분석수술성공솔,병발증급림상증상완해정황.결과 21례A형환자중,16례접수가탈구낭전새(구낭1～4개),술후즉시조영증실루구완전폐새소실15례,잔류소루구1례(＜20％).5례접수복막지가(직경4～5 mm,장도12～19mm)치료.치입2매지가1례,1매지가4례.루구완전폐새3례.1례잔류교대루구(＞50％),경지가여혈관벽적간극우해면두치입3개가탈구낭후루구완전폐새.지가치입후경내동맥급루구완전폐새1례.유우대측혈류대상량호,환자미발생뇌경사.7례B형화D형환자중,완전폐새환측해면두6례,잔류루구1례(＜50％).사용탄황권3～8개(평균6개),초액화전유여n-BCA혼합액적체적1.0～2.1 ml(평균1.3ml),주사시간45 ～90 s(평균65 s).림상증상완전완해26례,수방12 ～60개월,평균30개월.수방기간무복발병례,경동맥복막지가내미발생협착、폐새.결론 직접형CCF수선가탈구낭전새.암하두입로탄황권연합n-BCA전새시간접형CCF안전、유효적치료방안.
Objective To evaluate the feasibility and efficacy of endovascular treatment for different types of carotid cavernous fistula (CCF) via the approach of internal carotid artery ( ICA ) or inferior petrosal sinus (IPS).Methods From April 2005 to June 2010,28 CCF patients underwent endovascular treatment at our institution.There were 13 males and 15 females with a mean age of 39 years (range:21 -71 ).According to the Barrow's classification,they were classified into type A (n =21 ),type B (n =2) and type D (n =5).Patients of type A underwent detachable balloon embolization of ipsilateral cavernous sinus or stent-graft placement via the ICA approach.Patients of types B and D received detachable coil plus n-BCA (n-butyl-2-cyanoacrylate) embolization of ipsilateral cavernous sinus via the IPS approach.The technical results,complications and therapeutic outcomes were reviewed.Results Detachable balloons (number:1 -4) were used in 16 patients of type A.Angiography at immediate postembolization showed a complete occlusion of fistula in 15 patients and a small residual fistula ( ＜20％ ) in 1 patient.Five patients of type A received stent-graft placement.One stent was placed in 4 patients and 2 stents in 1 patient.Complete fistula closures with preserved ICA were documented on immediate angiogram in 3 patients whereas a large residual flow ( ＞ 50％ ) persisted in 1.The fistula was completely occluded after 3 detachable balloons were deployed in affected cavernous sinus through a gap between stent and vascular wall.Both fistula and ICA were occluded in 1 patient after stenting.No cerebral infarction was observed due to the adequate collateral blood flow from contralateral ICA.Complete closures of affected cavernous sinus were achieved in 6 patients of types B and D while residual flow ( ＜ 50％ ) persisted in 1.The number of detachable coils for each embolization ranged from 3 to 8 ( mean:6.0).The volume of n-BCA mixture varied from 1.0 to 2.1 ml (mean:1.3 ).The mean duration of n-BCA injection was 65 s (range:45 -90).Clinical symptoms were completely relieved in 26 patients.During the mean follow-up period of 30 months (range:12 -60),no recurrence of clinical symptoms was observed.No thrombosis or stenosis was found in the lumina of stents.Conclusion Detachable balloon embolization is the preferential treatment for direct CCF.Detachable coil plus n-BCA embolization of cavernous sinus via the IPS approach is an efficient and safe treatment for indirect CCF.