中间导管“特洛伊木马”技术输送Willis覆膜支架行颅内动脉腔内隔绝术治疗颈内动脉海绵窦病变  

Intermediate catheter " Trojan Horse" technique for delivery of Willis covered stents: intracranial endovascular exclusion for the treatment of cavernous sinus disease of internal carotid artery

作　　者：彭亚[1] 宣井岗[1] 陈荣华[1] 邵华明[1] 朱旭成[1] 曹洁[1] Peng Ya;Xuan Jinggang;Chen Ronghua;Shao Huaming;Zhu Xucheng;Cao Jie(Department of Neurosurgery,the First People＇s Hospital of Changzhou,the Third Affilated Hospital of Soochow University,Changzhou 213000,China)

机构地区：[1]常州市第一人民医院(苏州大学附属第三医院)神经外科,213000

出　　处：《中国脑血管病杂志》2018年第9期489-492,495,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的初步评价在颅内血管迂曲情况下,采用中间导管"特洛伊木马"技术,输送Willis覆膜支架至目标位置,实施颅内动脉腔内隔绝术治疗颈内动脉海绵窦病变的效果。方法回顾性纳入2018年1月至2月常州市第一人民医院神经外科2例颈内动脉海绵窦病变患者的临床资料。使用Willis覆膜支架,对1例外伤性颈内动脉海绵窦瘘(TCCF)和1例颈内动脉海绵窦段巨大动脉瘤进行动脉腔内隔绝血管重建术。由于患者血管迂曲,采用Navien中间导管"特洛伊木马"技术输送Willis支架到位,即在同轴导管系统下,先将5 F Navien中间导管头端越过病变部位,然后将Willis支架在中间导管内输送至病变部位,再回撤中间导管,Willis支架即可定位在病变血管段。结果 (1)2例术中Willis支架均顺利到位,球囊扩张后释放。1例TCCF因为支架在海绵窦近端弯曲处,回撤球囊支架略有移位,术后即刻造影显示略有对比剂内漏。对另1例颈内动脉海绵窦段巨大动脉瘤即刻造影,显示载瘤动脉通畅、动脉瘤不显影。(2)2例患者在术后1、3个月复查CT血管成像,显示血管重建良好。支架置入后1个月随访TCCF患者,突眼及杂音症状消失;术后3个月随访颈内动脉海绵窦段巨大动脉瘤患者,头痛症状消失,右侧动眼神经麻痹明显缓解。结论在迂曲颅内动脉使用中间导管"特洛伊木马"技术输送Willis覆膜支架到位,具有辅助作用,较传统颅内动脉腔内隔绝技术初显优势。Objective To preliminarily evaluate the efficacy of using intermediate catheter ＂ Trojan Horse＂ technique for delivery of Willis covered stents in place and conducing intracranial endovascular exclusion for the treatment of cavernous sinus disease of internal carotid artery under the condition of intracranial vascular tortuosity. Methods From January to February 2018,the clinical data of 2 patients with cavernous sinus disease of internal carotid artery at the Department of Neurosurgery,the First People＇s Hospital of Changzhou were enrolled retrospectively. Willis covered stent was used to perform arterial endovascular revascularization in one case of traumatic carotid-cavernous fistula（ TCCF） and arterial endovascular revascularization in one case of giant aneurysm in internal carotid cavernous segment. Due to vascular tortuosity,Navien intermediate catheter ＂ Trojan Horse＂ technique was used to deliver the Willis stents to the lesion smoothly. and then the Willis stent in the intermediate catheter was delivered to the lesion. Then withdraw to the intermediate catheter,Willis stent was located in the pathological vascular segment. Results（ 1） In the 2 cases,Willis covered stents were in place smoothly during the procedure and they were released after balloon dilatation. Because the stent was bent at the proximal cavernous sinus in one patient with TCCF,the stent was slightly displaced when the balloon was withdrawn. Angiographic findings immediately after operation showed a slight contrast leakage. Another patient with giant aneurysm in cavernous sinus segment of internal carotid artery,immediate angiography after procedure showed that the parent artery was patent and the aneurysm was undeveloped.（ 2） CT angiography in 2 patients at 1 and3 months after procedure showed that the vascular reconstruction was good. TCCF was followed up for one month after stenting,the symptoms of exophthalmos and murmur disappeared. Three months after procedure the headache symptoms disappeared and the right oc

关 键 词：颈动脉疾病 中间导管 Willis支架 腔内隔绝术 

分 类 号：R743[医药卫生—神经病学与精神病学]