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2008, vol. 65, br. 12, str. 923-926
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Endovaskularni tretman karotidno-kavernozne fistule tip A primenom platinskih spirala
Endovascular treatment of carotid-cavernous fistula type A with platinium coils
aVojnomedicinska akademija, Institut za radiologiju, Beograd bPoznan University of Medical Sciences, Department of Neuroradiology, Poznan, Poland cVojnomedicinska akademija, Klinika za neurohirurgiju, Beograd
e-adresa: slobostef@yahoo.com
Sažetak
Uvod. Karotidno-kavernozne fistule patološke su komunikacije između karotidnih arterija ili njihovih grana i kavernoznog sinusa i najčešće su prouzrokovane traumom. Posttraumatske fistule predstavljaju 70% svih karotidno-kavernoznih fistula i to su najčešće fistule visokog protoka (tip A). Taj tip fistula uvek daje izraženu očnu simptomatologiju. Prikaz bolesnika. Prikazan je bolesnik muškog pola, starosti 44 godine, sa ustrelnom povredom glave, kod koga se, kao posledica povrede razvila karotidno-kavernozna fistula. U kliničkoj slici postojali su egzoftalmus desnog oka, hemoza i slabljenje vida na tom oku, glavobolja i diplopija. Digitalnom suptrakcionom angiografijom postavljena je dijagnoza karotidno-kavernozne fistule visokog protoka, koja je bila vaskularizovana delom iz leve karotidne arterije, a delom iz vertebrobazilarnog sliva. Nakon završene dijagnostike, urađena je endovaskularna embolizacija platinskim spiralama transarterijskim putem. Kontrolnom angiografijom potvrđeno je da je fistula zatvorena. Zaključak. Embolizacija kompleksne karotidno-kavernozne fistule tip A uspešno je izvršena endovaskularnim putem, upotrebom platinskih spirala.
Abstract
Background. Carotid-cavernous fistulas are abnormal communications between carotid arteries or their branches and the cavernous system caused mostly by trauma. Posttraumatic fistulas represent 70% of all carotid-cavernous fistulas and they are mostly high-flow shunts (type A). This type gives characteristic eye symptoms. Case report. This paper presents a 44-year old male patient with carotidcavernous fistula as a result of penetrating head injury. In clinical presentation the patient had exophthalmos, conjunctival chemosis and weakening of vision on the right eye, headache and diplopia. Digital subtracted angiography showed high-flow carotid-cavernous fistula, which was vascularised from the left carotid artery and from vertebrobasilar artery. Endovascular embolization with platinum coils was performed through the transarterial route (endoarterial approach). Check angiogram confirmed that the fistula was closed and that no new communications developed. Conclusion. Embolization of complex carotidcavernous fistula type A was successfully performed with platinum coils by endovascular approach.
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