CAN THIỆP GÂY TẮC MẠCH MANG: NHÂN 2 TRƯỜNG HỢP GIẢ PHÌNH MẠCH KHỔNG LỒ TRONG RÒ ĐỘNG MẠCH CẢNH XOANG HANG=Endovascular parent artery sacrifice in giant pseudoaneurysms of cavernous carotid fistula: Report 2 cases

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Tác giả: Văn Khoa Lê, Huỳnh Nhật Tuấn Nguyễn, Văn Tiến Bảo Nguyễn, Đăng Tú Phạm

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Điện quang và Y học hạt nhân Việt Nam, 2024

Mô tả vật lý: tr.94-99

Bộ sưu tập: Metadata

ID: 486991

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Giới thiệu ca bệnh: Rò động mạch cảnh xoang hang (RĐMCXH ) kèm giả phình mạch khổng lồ rất hiếm gặp theo y văn trên thế giới. Chúng tôi báo 2 ca bệnh đặc biệt của rò động mạch cảnh xoang hang với sự giãn lớn giả phình mạch khổng lồ vùng xoang hang, được điều trị can thiệp nội mạch (CTNM) thành công tại Bệnh viện Chợ Rẫy. Ca 1 là bệnh nhân nam 38 tuổi, tiền sử chấn thương 20 năm vào viện vì đau đầu cấp, hình ảnh CT/DSA là RĐMCXH phải với giãn dạng khổng lồ giả phình vùng xoang hang KT# 61,9x57,8x56,7 mm, giãn lớn tĩnh mạch vỏ não, và điều đặc biệt là lỗ rò cấp máu qua động mạch thông trước và thôngsau đối bên, trong khi đó động mạch cảnh trong phải tắc mạn tính tại gốc. CTNM tiếp cận lỗ rò từ động mạch đốt sống qua động mạch thông sau phải vào lỗ rò, tắc hoàn toàn lỗ rò bằng coils, bảo tồn động mạch cảnh trong trên lỗ rò. Ca 2 là bệnh nhân trẻ nam 20 tuổi, tiền sử chấn thương 1 năm, vào viện vì chảy máu mũi lượng nhiều. Hình ảnh MRI/DSA là RĐMCXH phải với giãn dạng khổng lồ giả phình vùng xoang hang hàm mặt phải KT# 98,8x87,7x96,7 mm, kèm giả phình nhỏ cạnh vị trí lỗ rò, với huyết khối chiếm phần lớn bên trong giả phình. Làm test tắc động mạch cảnh cùng bên giả phình ghi nhận bàng hệ động mạch thông trước và thông sau tốt. CTNM tiếp cận tắc vị trí ngay lỗ rò và động mạch cảnh vị trí tương ứng bằng coils. Cả hai ca bệnh có diễn tiến sau can thiệp tốt và xuất viện sau đó 3 ngày.Introduction: Cavernous carotid artery fistula (CCF) with giant pseudoaneurysm is very rare according to world medical literature. We reported 2 rare cases of CCF with giant pseudoaneurysm in the cavernous sinus fistula, successfully treated with endovascular intervention (ET) at Cho Ray Hospital. Case 1 is a 38-year-old male patient with a 20-year history of trauma who was admitted to the hospital because of an acute headache. The CT/DSA image was of the right ICA with giant pseudoaneurysm dilatation in the cavernous sinus fistula, the size # 61.9x57.8x56.7 mm , large dilated cortical veins, and especially the fistula that supplies blood through the contralateral anterior and posterior communicating arteries, while the right ICA is chronically occluded at its origin. ET approached the fistula from the vertebral artery through the right posterior communicating artery into the fistula, completely occluding the fistula with coils, preserving the internal carotid artery above the fistula. Case 2 is a 20-year-old male patient, with a history of trauma for 1 year, and was admitted to the hospital because of a epistaxis. The MRI/DSA image is of the right ICA with giant pseudoaneurysm dilatation in the right maxillofacial sinus area, size # 98.8x87.7x96.7 mm, with a small pseudoaneurysm next to the fistula site, with thrombus occupying the majority inside pseudoaneurysm. Doing a carotid artery occlusion test on the same side of the pseudoaneurysm revealed good anterior and posterior communicating arterial collaterals. ET approached the occlusion position right at the fistula and the internal carotid artery with coils. Both cases had good outcome afer ET and were discharged from the hospital 3 days later.

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