ABSTRACT
Objective:To explore the efficacy of Matas test combined with endovascular intervention on patients with traumatic internal carotid-cavernous fistula.Methods:A retrospective case study was performed on 144 patients with traumatic internal carotid-cavernous fistula treated in our department from August 2012 to June 2018. The clinical symptoms, intraocular pressure and visual acuity data before and after surgery were counted, and the paired t test was used for statistical analysis. Logistic regression was performed to analyze factors affecting recurrence.Results:The main symptoms of traumatic internal carotid-cavernous fistula were proptosis, bulbar conjunctival hyperemia and cranial sound. Postoperative intraocular pressure was significantly lower than preoperative intraocular pressure [(11.13±2.97) mmHg vs. (22.37±6.64) mmHg] and postoperative visual acuity was significantly higher than preoperative visual acuity [(0.69±0.36) vs. (0.47±0.25)] and (both P<0.05). Postoperative intraocular pressure was an independent risk factor for recurrence within 3 months ( OR=0.357, 95% CI: 0.135-0.944, P=0.037), and the recurrence rate was 10.42%. Conclusions:Matas test combined with endovascular intervention in the treatment of traumatic internal carotid-cavernous fistula can effectively reduce intraocular pressure, improve visual acuity, and has a definite curative effect. It is one of the effective treatment methods for traumatic internal carotid-cavernous fistula.
ABSTRACT
Objective To investigate the flexibility of both the covered stents specially designed for use in intracranial vasculature and the delivering system in passing through the bone tube and the physiological curves of the cranial internal carotid artery(CICA)to reach the targeted area,the performance (adherence)of the covered stents in occluding vascular wall diseases and the impact on the vascular branches of the covered segment.Methods The covered stents specially designed for use in intracranial vaseulature were used to treat 13 patients with CICA diseases using endovascular techniques.There were 4 huge pseudoaneurysms,4 giant aneurysms,3 small wide-necked aneurysms,1 giant pseudoaneurysm with concurrent internal carotid cavernous fistula(CCF),and 1 CCF.Prior to the detachment of the covered stents,balloon occlusion test(BOT)of the internal carotid artery on the diseased side and whole-brain digital subtraction angiography(DSA)were performed in all the patients.Three to 16 months following procedure,DSA and clinical follow-ups were performed.Results Thirteen patients all tolerated the BOT well with the DSA demonstrating well-opened anterior and posterior communicating arteries.The covered stents and the delivering systems all successfully passed CICA to reach the targeted diseased area,with the diseased segments of the internal carotid artery including C3—C4 in 4 cases,C4—C5 in 4 and C6—C7 in 5.Immediately following the detachment of the covered stents,DSA demonstrated that 7 aneurysms were completely occluded,4 aneurysms had slight endoleak,and 1 CCF had markedly-decreased blood flow through the fistula.In the patient with concurrent pseudoaneurysm and CCF,the pseudoaneurysm disappeared and the blood flow through the fistula was markedly-reduced immediately following the stenting procedure.Apart from one patient with aneurysmal subarachnoid hemorrhage who died due to extensive vascular spasm on the 9th day following the stenting procedure,all the other 12 patients had unobstructed stented vessels on the follow-up DSA images,with 2 demonstrating slight stenosis.In the 6 patients with post-procedure endoleak,DSA showed that the endoleak in 4 patients had disappeared,one endoleak disappeared following the second stenting,and one CCF remained low-flow fistula.There was no sequela related to the occlusion of branches in the covered arterial segment.Conclusion The covered stents specially designed for use in the intracranial vasculature and the delivering system are both flexible enough to pass the tortuous CICA to reach the intracranial diseased artery,and are effective in managing CICA diseases.Further follow-up is still needed to determine the long-term effect of the covered stents,and the adherence of the covered stents needs further investigation.
