外伤性颈内动脉虹吸段假性动脉瘤的介入治疗

Interventional therapy of traumatic pseudoaneurysms in internal carotid artery siphon

目的探讨颈内动脉(internal carotid artery,ICA)虹吸段假性动脉瘤血管内介入治疗的方法和疗效。方法12例外伤性 ICA 虹吸段假性动脉瘤,经 DSA 确诊后即行 Willis 环侧支循环功能试验,根据 Willis 环前、后侧支循环代偿情况采用不同的治疗方法。10例行 ICA 完全闭塞,1例应用电解可脱弹簧圈(GDC)填塞动脉瘤,1例未行治疗。结果 12例动脉瘤中,9例行 ICA 闭塞后痊愈。3例脑 Willis 环循环功能不良,其中1例采用 GDC 行动脉瘤填塞治愈;1例 Willis 环前、后侧支循环代偿功能不良,行患侧 ICA 球囊闭塞(balloon test occlusion,BTO)试验30 min,患者意识、肢体活动正常,用可脱性球囊闭塞 ICA,48 h 后死亡;1例未行栓塞,行改善侧支循环功能训练期间鼻出血死亡。结论 ICA 虹吸段假性动脉瘤经脑 Willis 环 BTO 试验筛选后可行 ICA 闭塞治疗。

Objective To determine the methods and results of treating traumatic pseudoaneurysms in siphon segment of internal carotid artery （ICA） by interventional therapy. Methods Twelve cases of traumatic pseudoaneurysms in siphon segment of internal carotid artery were treated. The collateral circulation of Willis circle was observed after DSA. Different methods of treatment were applied according to the collateral circulation of Willis circle. Ten cases were treated by occlusion of ICA completely, 1 case was embolized by guglielmi detachable coil （GDC） only. Results Nine of 12 treated by occlusion of ICA were cured. In the 3 cases who had poor collateral of Willis circle, one was cured by GDC embolization alone; one died 48 hours later after ICA occlusion though his consciousness and the activity of extremities were normal during the temporary balloon test occlusion （BTO） of ICA. One died during the training to improve the collateral of the Willis circle. Conclusion ICA embolization is feasible for treatment of traumatic pseudoaneurysms in siphon segment of internal carotid artery after evaluating the collateral circulation of Willis circle.