Willis覆膜支架在外伤性颈动脉海绵窦瘘的应用体会

Application of Willis Covered Stent in Traumatic Carotid Cavernous Sinus Fistula

摘要: 目的：探讨Willis覆膜支架在外伤性颈动脉海绵窦瘘(traumatic carotid cavernous sinus fistula, TCCF)介入治疗中的有效性和安全性。方法：回顾性分析本中心接受Willis覆膜支架介入治疗的7例TCCF患者的临床资料。结果：7例TCCF患者均无围手术期并发症，术后即刻造影7例瘘口均完全消失，术后临床症状均明显缓解。其中2例单用Willis覆膜支架即刻瘘口未消失，存在较为明显内漏，后经静脉入路分别予可解脱弹簧圈联合Onyx胶栓塞、单独Onyx胶栓塞后瘘口消失。随访显示7例瘘口完全消失，颈内动脉通畅，临床症状明显好转。结论：本中心的初步经验显示，Willis覆膜支架可作为部分TCCF患者的一种治疗选择，尤其是在处理内漏方面积累了一定经验，其长期有效性和在TCCF治疗中的确切地位有待更大规模的前瞻性研究加以明确。

Abstract: Objective: To investigate the efficacy and safety of the Willis covered stent in the interventional treatment of traumatic carotid cavernous sinus fistula (TCCF). Methods: The clinical data of 7 TCCF patients who were treated with Willis covered stent-graft intervention in our center were analyzed retrospectively. Results: None of the 7 patients with TCCF had perioperative complications, the 7 fistulas completely disappeared on postoperative immediate contrast, and all the clinical symptoms were obviously relieved after the operation. Two cases of Willis covered stent alone did not disappear immediately, and there was an obvious leakage. The fistula disappeared after the reloadable coil combined with Onyx embolization and Onyx embolization alone by the posterior transvenous approach respectively. Follow-up showed complete disappearance of fistula and patency of the internal carotid artery in 7 cases, and obvious improvement of clinical symptoms. Conclusion: Preliminary experience at our center indicates that Willis covered stents may serve as a treatment option for some TCCF patients, particularly in managing endoleaks where we have gained considerable experience. Their long-term efficacy and precise role in TCCF management require confirmation through larger prospective studies.