Value of inferior petrosal sinus digital substraction angiography analysis in endovascular treatment of carotid cavernous fistulas
10.3760/cma.j.cn115354-20200903-00710
- VernacularTitle:岩下窦的DSA图像分析对血管内治疗颈动脉海绵窦瘘的指导价值
- Author:
Xianqun WU
1
;
Jingfang HONG
;
Haibing LIU
;
Shousen WANG
Author Information
1. 福建医科大学福总临床医学院（第九〇〇医院）神经外科，福州 350025
- Keywords:
Inferior petrosal sinus;
Carotid cavernous fistulas;
Endovascular treatment;
Digital substraction angiography
- From:
Chinese Journal of Neuromedicine
2021;20(3):258-263
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the digital substraction angiography (DSA) features of inferior petrosal sinus (IPS) in patients with carotid cavernous fistulas (CCF), and explore its guiding value in endovascular treatment of CCF.Methods:The surgical process and whole brain DSA images of 76 CCF patients accepted endovascular treatment in our hospital from January 2013 to December 2019 were retrospectively analyzed. These patients were divided into direct CCF group ( n=52) and indirect CCF group ( n=24) according to the Barrow typing. The development of IPS in the affected side of the 2 groups was compared, and the location of IPS entry into the internal jugular vein (IJV) in patients from direct CCF group and indirect CCF group during the whole process of IPS development was compared, and the efficacy of endovascular treatment of CCF by IPS was analyzed. Results:Indirect CCF group had significantly higher proportion of patients with poor visualization (45.8%, 11/24) as compared with direct CCF group (17.3%, 9/52, P<0.05). Except one patient with IPS not connecting to IJV, the proportion of intracranial IPS-IJV junction showed no significant difference between the two groups ( P>0.05). IPS embolization was the first choice for all the 24 indirect CCF patients: 13 patients with IPS whole-process development had a relatively smooth superselecative cathelerization (reperfusion rate=100%), and the time of microcatheter placement was relatively short (32 min on average); in the 11 patients with poor IPS development, 5 were successfully opened by loach guidewire guidance and microguide wire looping technique (reperfusion rate=45%), and microcatheter placement was relatively long (69 min on average). Conclusions:Indirect CCF has a high rate of IPS occlusion. Lateral and 3D images show that IPS is parallel to the petrous bone segment of internal carotid artery. Mastering the course of IPS and the location of its terminal into IJV has very important value for guiding the microcatheter to enter the cavernous sinus through the poorly visualized IPS.
