外伤性颈动脉海绵窦瘘球囊栓塞术后复发危险因素分析及治疗

The analysis of risk factors and the treatment of recurrent traumatic carotid cavernous fistulas previously managed with detachable balloons

目的探讨可脱球囊栓塞治疗外伤性颈动脉海绵窦瘘(traumatic carotid cavernous fistula,TCCF)术后复发的危险因素及再治疗策略。方法回顾分析采用可脱球囊栓塞治疗的58例TCCF病例资料,随访时间为3个月～3年。同时将病例按首次可脱球囊栓塞治疗后有无复发分为复发组(7例)和未复发组(51例)。选择性别、瘘口位置、外伤至介入治疗时间间隔、CCF瘘口流量、使用球囊数量、是否闭塞颈内动脉(ICA)等因素作为研究参数,探讨可脱球囊栓塞治疗TCCF复发的危险因素。结果可脱球囊栓塞成功治疗所有58例TCCF(其中7例ICA被闭塞),随访过程中7例出现复发。单因素分析提示外伤至介入时间间隔是影响术后复发的危险因素。复发病例中,4例再次采用可脱球囊栓塞瘘口,2例闭塞ICA,1例接受覆膜支架置入治疗。结论可脱球囊栓塞是TCCF及复发性TCCF性价比较高的首选治疗方法,该方法存在一定的复发率,外伤至介入治疗时间间隔可能是影响术后复发的重要因素。

Objective To analyze the risk factors of recurrent traumatic carotid cavernous fistulas （TCCF） which had previously been managed with detachable balloons, and to discuss the strategy of its treatment. Methods Over the past 7 years, 58 patients with TCCF underwent transarterial detachable balloon embolization. All the patients were followed up for 3 months to 3 years. According to the presence or absence of recurrence after the initial treatment, the patients were divided into recurrent group （n = 7） and non-recurrent group （n = 51）. The relevant factors, including the sex, the fistula location, the interval between trauma and interventional procedure, the blood flow of CCF, the number of used balloons and the sacrifice of ICA, were evaluated. The possible risk factors causing recurrence were discussed. Results All 58 TCCFs were successfully treated with transarterial balloon emholization, of which sacrifice of ICA was carried out in 7. During the follow-up period recurrent fistula occurred in 7 patients. Single factor analysis indicated that the interval between trauma and interventional procedure performance was the main risk factor causing the recurrence of TCCF. Of the 7 recurrent patients, repeated transarterial balloon embolization was carried out in 2, occlusion of ICA in 2 and implantation of covered stent in one. Conclusion The detachable balloon embolization has still been the treatment of first choice for TCCF and recurrent TCCF, although this technique carries a certain recurrence rate. The interval between trauma and interventional procedure may be th e main risk factor of recurrence.