Willis覆膜支架治疗颈动脉海绵窦瘘：经验及文献复习

Endovascular Treatment of Carotid-Cavernous Fistulas by Using Willis Covered Stent: Experience and Review

摘要: 目的：探讨Willis覆膜支架治疗颈动脉海绵窦瘘(carotid cavernous fistulas, CCFs)的安全性及有效性。方法：回顾分析8例于本中心接受Willis支架治疗患者的临床资料。结果：全部患者手术顺利，无围手术期并发症发生。术后即刻血管造影显示5例瘘口完全消失，2例支架近端存在内漏，1例瘘口残留有。术后临床症状明显缓解。随访(4~16个月)显示：临床症状均消失，6例瘘口完全消失，1例瘘口残留，1例未复查血管造影。结论：Willis覆膜支架治疗颈内动脉海绵窦瘘安全、有效。

Abstract: Objective: The purpose of this study is to describe our experiences about the treatment of carot-id-cavernous fistulas (CCFs) with Willis covered stents and to evaluate whether a covered stent has a potential to be used as the first choice in selected cases. Methods: From January 2017 to January 2018, 8 patients underwent covered stent placement for CCFs occlusion. Clinical and angiographic data were retrospectively reviewed. Results: Access and deployment of a covered stent was successful in all patients (100%), without any periprocedural complications. Complete occlusion was achieved in five cases immediately after stent deployment. Endoleak was observed in two cases and re-dilation of the balloon was performed to attenuate the endoleak. In case 3, the fistula was residual mainly drained from pterygoid venous plexus. Clinical follow-up (FU) combined digital subtraction angiography (DSA) was performed. Finally, 8 cases received clinical FU and 7 cases imaging FU. The period of follow-up was from 4 months to 16 months. The symptom in all patients completely released and total occlusion of the fistula achieved in 6 cases, verified by DSA. Inter-estingly, the fistula in case 3 was also residual, however, the drainage vein transformed to sylvian fissure vein and Labbe vein. Conclusion: Although larger sample and long-term follow-up are re-quired, our series shows that Willis covered stent is an effective and safe method to treat CCFs.