1
|
Yuan J, Yang R, Zhang J, Liu H, Ye Z, Chao Q. Covered Stent Treatment for Direct Carotid-Cavernous Fistulas: A Meta-Analysis of Efficacy and Safety Outcomes. World Neurosurg 2024:S1878-8750(24)00650-8. [PMID: 38663732 DOI: 10.1016/j.wneu.2024.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Direct carotid-cavernous fistulas (dCCFs) involve the abnormal shunting of blood between the internal carotid artery and the cavernous sinus. The use of covered stents (CSs) has been reported for the treatment of complex carotid artery lesions. However, the efficacy and safety of CS treatment for dCCFs remain controversial. Thus, we performed a systematic review and meta-analysis to evaluate these efficacy and safety endpoints. METHODS A systematic literature review was performed by comprehensively searching the Medline, Embase, and Web of Science databases to identify studies that were related to CS treatment for dCCFs. Then, a meta-analysis was conducted to pool the efficacy and safety outcomes from these studies based on perioperative and follow-up data. RESULTS Fourteen noncomparative studies enrolling 156 patients with 160 dCCFs met the inclusion criteria. When analyzing perioperative outcomes, the technical success rate was 98.5% [95% confidence interval (CI), 0.948; 1.000], and the immediate complete occlusion rate was 90.9% (95% CI, 0.862; 0.959). Vasospasm and dissection occurred in 32.2% (95% CI, 0.238; 0.463) and 0.1% (95% CI, 0.000; 0.012) of patients, respectively. The in-stent acute thrombus formation rate was 0.1% (95% CI, 0.000; 0.013). Postoperatively, the mortality rate was 0.1% (95% CI, 0.000; 0.013). Based on available follow-up data, the final complete occlusion and parent artery stenosis rates were 99.3% (95% CI, 0.959; 1.000) and 18.6% (95% CI, 0.125; 0.277), respectively. CONCLUSIONS CS placement can be used to safely and effectively treat dCCFs. These results provide a reference for future clinical trials.
Collapse
Affiliation(s)
- Jiang Yuan
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Rongwei Yang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jiatong Zhang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hexu Liu
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ziming Ye
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qin Chao
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| |
Collapse
|
2
|
Koh DH, Choi HC, Shin HS, Baek HJ, Koh EH, Park MJ, Choi DS. Endovascular Treatment of Traumatic Vascular Injuries in the Head and Neck Region. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:269. [PMID: 38399556 PMCID: PMC10890514 DOI: 10.3390/medicina60020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Traumatic vascular injuries of the head and neck pose significant treatment challenges due to the complex anatomy, diverse clinical presentation, and mostly emergent nature. Endovascular treatment increasingly complements traditional surgical approaches. This study aimed to report our 10-year experience in treating traumatic vascular injuries of the head and neck with endovascular therapy and to determine the effectiveness of endovascular treatment. Materials and Methods: A retrospective analysis of 21 patients treated for head and neck vascular injuries between May 2011 and April 2021 was performed. Patients' medical histories, clinical presentations, imaging findings, treatment materials, and clinical outcomes were reviewed. Treatments included stenting, coil embolization, and other endovascular techniques focused on hemostasis and preservation of the parent vessel. Results: The most common injuries involved the internal maxillary artery branches (n = 11), followed by the common or internal carotid artery (n = 6), vertebral artery (n = 3), and others. Endovascular treatment achieved successful hemostasis in all but one case. In five of six carotid artery injuries and two of three vertebral artery injuries, we achieved successful hemostasis while preserving the parent vessel using covered and bare stents, respectively. Conclusions: Endovascular therapy might be a useful treatment modality for traumatic vascular injuries in the head and neck region, offering efficacy, safety, and a minimally invasive approach.
Collapse
Affiliation(s)
- Dong Hyun Koh
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
| | - Hye Jin Baek
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
| | - Eun Ha Koh
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Gyeongsang Institute of Medical Science, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
| | - Mi Jung Park
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
| | - Dae Seob Choi
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
- Gyeongsang Institute of Medical Science, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
| |
Collapse
|
3
|
Wu YM, Lin CM, Giri S, Chen YL, Chang CH, Wong HF. Comparing transvenous coiling and transarterial embolization with Onyx/NBCA for cavernous sinus dural arteriovenous fistulas: a retrospective study in a single center. Biomed J 2023:100657. [PMID: 37660902 DOI: 10.1016/j.bj.2023.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Endovascular management is the gold standard for cavernous sinus dural arteriovenous fistulas (CS-dAVFs) in patients with signs of ophthalmoplegia, visual defects, or intolerable clinical symptoms. Although the efficacy of embolization has been confirmed, complications during post-endovascular management have not been compared in a more extensive CS-dAVFs case series. Therefore, we compared the effectiveness and peri-procedural complications of transvenous coiling with those of transarterial embolization (TAE) using liquid embolic agents. MATERIAL AND METHODS We reviewed 71 patients with CS-dAVFs in one medical center from 2005/7 to 2016/7. We performed seventy-seven procedures on 71 patients, including six recurrent cases. We compared the efficacy and peri-procedural complications of transvenous coiling and TAE. RESULTS The complete occlusion rate for transvenous coiling was 79.2%, and that for TAE was 75.0%. Findings revealed (1) similar ophthalmoplegia complication rates (p = 0.744); (2) more frequent and permanent CN5 or CN7 neuropathy with liquid embolic agent use (p = 0.031 and 0.028, respectively); and (3) a higher risk of infarction or ICH (p =0.002 and 0.028, respectively) in response to aggressive TAE. CONCLUSION Transvenous cavernous sinus coiling resulted in a similar occlusion rate and lower complication risk than transarterial Onyx/n-butyl cyanoacrylate (NBCA). We can access via an occluded inferior petrosal sinus (even contralateral), and direct transorbital puncture was a safe alternative. TAE with Onyx/NBCA was helpful in cases of oligo-feeders, but multidisciplinary treatment and multi-session TAE were usually needed for patients with multiple feeders and complex fistulas.
Collapse
Affiliation(s)
- Yi-Ming Wu
- Department of Medical imaging and intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chuan-Min Lin
- Department of Neurology, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
| | - Sachin Giri
- Fellowship in Department of Medical imaging and intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Dr L.H. Hiranandani Hospital, Powai, Mumbai, India
| | - Yao-Liang Chen
- Department of Medical imaging and intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ho-Fai Wong
- Department of Medical imaging and intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| |
Collapse
|
4
|
Han JW, Lee JI, Hwangbo L. [Endovascular Treatment for Head and Neck Trauma]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:792-808. [PMID: 37559799 PMCID: PMC10407061 DOI: 10.3348/jksr.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 08/11/2023]
Abstract
Trauma to the head and neck region can have serious consequences for vital organs such as the brain, and injuries to blood vessels can cause permanent neurological damage or even death. Thus, prompt treatment of head and neck vessels is crucial. Although the level of evidence is moderate, an increasing amount of research indicates that endovascular treatments can be a viable alternative to traditional surgery or medical management. Embolization or reconstructive endovascular procedures can significantly improve patient outcomes. This article provides an overview of various endovascular options available for specific clinical scenarios, along with examples of cases in which they were employed.
Collapse
|
5
|
Duangprasert G, Sukhor S, Kaewprasert T, Tantongtip D. Traumatic Supraclinoid Internal Carotid Artery Pseudoaneurysm associated with Carotid-Cavernous Fistula and Contralateral Anterior Cerebral Artery Pseudoaneurysm Treated by Surgical Trapping with High-Flow Bypass and A3-A3 Bypass: A Case Report and Literature Review. Asian J Neurosurg 2023; 18:184-190. [PMID: 37056887 PMCID: PMC10089730 DOI: 10.1055/s-0043-1761239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
AbstractTraumatic pseudoaneurysms of the supraclinoid internal carotid artery (ICA) are uncommon, particularly associated with carotid-cavernous fistulas (CCF) or multiple traumatic aneurysms. This report describes a patient with a ruptured left ICA dissecting pseudoaneurysm that caused a direct CCF and a right anterior cerebral artery (ACA) pseudoaneurysm. To eliminate the aneurysm and fistula, we followed the universal bypass strategy by performing an ICA trapping with high-flow bypass, followed by an ACA trapping with A3-A3 side-to-side bypass. Herein, we report the first successful surgical trapping and revascularization of supraclinoid ICA pseudoaneurysm associated with a direct carotid-cavernous fistula.
Collapse
|
6
|
Petrov I, Stankov Z, Boychev D, Klissurski M. Use of coronary stent grafts for the treatment of high-flow carotid cavernous fistula. BMJ Case Rep 2021; 14:14/11/e245922. [PMID: 34764121 PMCID: PMC8587380 DOI: 10.1136/bcr-2021-245922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Carotid cavernous fistulas are abnormal communications between the carotid artery or its branches and the cavernous sinus. It can be traumatic or spontaneous. The widely accepted treatment is by detachable balloons. Advancements in the field of endovascular medicine made available other options for the treatment of this condition. Covered stents are widely available and offer preservation of the parent artery while occluding the fistula.
Collapse
Affiliation(s)
- Ivo Petrov
- Cardiology, Angiology and Electrophysiology, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Zoran Stankov
- Cardiology, Angiology and Electrophysiology, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Damyan Boychev
- Cardiology, Angiology and Electrophysiology, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Marko Klissurski
- Neurology, Acibadem City Clinic cardiovascular Center, Sofia, Bulgaria
| |
Collapse
|
7
|
Liu Q, Qi C, Wang Y, Su W, Li G, Wang D. Treatment of direct carotid-cavernous fistula with Willis covered stent with midterm follow-up. Chin Neurosurg J 2021; 7:41. [PMID: 34517922 PMCID: PMC8436539 DOI: 10.1186/s41016-021-00256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Willis covered stent is the first stent designed exclusively for intracranial vasculature, and its application in carotid-cavernous fistula is limited. The aim is to evaluate the feasibility and efficacy of this device in treating direct carotid-cavernous fistula. Methods Ten consecutive patients with direct carotid-cavernous fistula were treated in our institution with Willis covered stents from September 2013 to December 2015. The characteristics of these patients and the immediate and follow-up results were retrospectively reviewed. Results Of the 10 patients, 8 were treated for the first time, and 2 had been treated elsewhere. Willis covered stents were successfully released in 9 patients. Abnormal arteriovenous shunt disappeared in 6 cases immediately after stent deployment and endoleak occurred in 3 cases. Endoleak disappeared at 6-month angiography follow-up in one case and was sealed with coils through a pre-set microcatheter in another case. Parent artery was sacrificed as endoleak remained despite repeated balloon dilation and a second stent deployment in the third case. All patients got clinical follow-ups for at least 24 months and 7 patients received angiographic follow-up. Symptoms were relieved gradually in all cases except for slight oculomotor paralysis and visual acuity in one case, respectively. In-stent stenosis was found in 1 case, and no recurrence was observed. Conclusions Willis covered stent is feasible for direct carotid-cavernous fistula.
Collapse
Affiliation(s)
- Qinglin Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Universitys, 119#, Nansihua Xi Road, Fengtai District, Beijing, 100050, China
| | - Changjing Qi
- Nursing Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Yunyan Wang
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Wandong Su
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Gang Li
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Donghai Wang
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China.
| |
Collapse
|
8
|
Wang T, Richard SA, Zhang C, Xie X, Wang C. The Appearance of Middle Meningeal Artery Fistulae After Willis Covered Stent for Traumatic Carotid-cavernous Fistulae: Two Case Reports. Curr Med Imaging 2021; 17:1025-1030. [PMID: 33459242 DOI: 10.2174/1573405617666210114142800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/13/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Carotid cavernous fistulae (CCF) are rare, and they occur when there is a communication between the internal carotid artery (ICA) and cavernous sinus. These lesions are associated with blunt or penetrating traumatic injuries of the carotid arteries. We present the first cases of cavernous dural arteriovenous fistulae (cDAVF) in the middle meningeal artery (MMA) after the treatment of direct CCF in the ICA with Willis-covered stents (WCSs). CASE PRESENTATION Our patients comprised 22 and 50-year-old males with histories of head injuries months before admission at our facility. In both patients above, cerebral angiography revealed fistulae in the right ICA and left ICA, respectively. They were treated with WCSs via the trans-artery endovascular route. In both cases, the treatments were not in the way attempted via the MMA. Subsequently, they developed cDAVF in the middle meningeal artery (MMA), which were treated with Onyx Liquid Embolic System (Onyx HD-500) (Covidien / ev3 Neurovascular) and conservatively, respectively. CONCLUSION These are the first cases in whom WCSs for the management of direct CCF resulted in cDAVF at the MMA. The WCSs inside the ICA could have resulted in the cDAVF via unknown mechanisms but not iatrogenic.
Collapse
Affiliation(s)
- Ting Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, China
| | - Seidu A Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, China
| | - Changwei Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, China
| | - Xiaodong Xie
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, China
| | - Chaohua Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, China
| |
Collapse
|
9
|
Jeong SH, Lee JH, Choi HJ, Kim BC, Yu SH, Lee JI. First line Treatment of Traumatic Carotid Cavernous Fistulas Using Covered Stents at Level 1 Regional Trauma Center. J Korean Neurosurg Soc 2021; 64:818-826. [PMID: 34293848 PMCID: PMC8435656 DOI: 10.3340/jkns.2020.0345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/07/2021] [Indexed: 01/06/2023] Open
Abstract
Objective The widely accepted treatment option of a traumatic carotid cavernous fistula (TCCF) has been detachable balloon or coils based fistula occlusion. Recently, covered stent implantation has been proving an excellent results. The purpose of this study is to investigate our experiences with first line choice of covered stent implantation for TCCF at level 1 regional trauma center.
Methods From November 2004 to February 2020, 19 covered stents were used for treatment of 19 TCCF patients. Among them, 15 cases were first line treatment using covered stents. Clinical and angiographic data were retrospectively reviewed.
Results Procedures were technically successful in all 15 cases (100%). Immediate angiographic results after procedure were total occlusion in 12 patients (80%). All patients except two expired patients had image follow-up (mean 15 months). Recurred symptomatic three patients underwent additional treatments and achieved complete occlusion. Mean clinical follow-up duration was 32 months and results were modified Rankin Scale 1–2 in five, 3–4 in five, and 5 in three patients.
Conclusion The covered stent could be considered as fist line treatment option for treating TCCF patients especially in unstable vital sign. Larger samples and expanded follow-up are required to further develop their specifications and indications.
Collapse
Affiliation(s)
- Sang Hoon Jeong
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jung Hwan Lee
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Byung Chul Kim
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seung Han Yu
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| |
Collapse
|
10
|
Ide S, Kiyosue H, Tokuyama K, Hori Y, Sagara Y, Kubo T. Direct Carotid Cavernous Fistulas. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:583-592. [PMID: 37502141 PMCID: PMC10370662 DOI: 10.5797/jnet.ra.2020-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 07/29/2023]
Abstract
A direct carotid cavernous fistula (CCF) is an abnormal shunt between the internal carotid artery (ICA) and the cavernous sinus (CS). Traumatic CCF is the most common type, accounting for up to 75% of all CCFs. For the management of direct CCF, endovascular therapy has become the standard. For successful endovascular therapy, evaluation of the size and location of orifice of the CCF, venous drainage, and tolerance for ICA occlusion on cerebral angiography is necessary. Multi-planner reformatted images of 3D rotation angiography are useful to visualize the fistula and compartments of the CS precisely. Due to the limited commercial availability of detachable balloons, detachable coils have become a widely employed endovascular tool for the treatment of direct CCFs. The advantageous aspects of coil application are their easy retrievability and better control. In the case of large/multiple fistulas, adjunctive techniques, including balloon- and stent-assisted techniques, are often needed to occlude the CCF while preserving the ICA. To avoid cranial nerve palsy related to over-packing of the CS with detachable coils or a detachable balloon, selective embolization of the fistula portion is required. Use of liquid embolic materials and covered stents was recently reported as another adjunctive technique. In cases in which it is impossible to occlude the CCF while preserving the ICA, parent artery occlusion (PAO) is considered. The selection of additional/alternative techniques and devices depends on the anatomy and hemodynamics of each CCF, and the skill and experience of individual operators.
Collapse
Affiliation(s)
- Satomi Ide
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Hiro Kiyosue
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kohei Tokuyama
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yuzo Hori
- Department of Radiology, Nagatomi Neurosurgical Hospital, Oita, Oita, Japan
| | - Yoshiko Sagara
- Department of Radiology, Tsurumi Hospital, Beppu, Oita, Japan
| | - Takeshi Kubo
- Department of Neurosurgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
| |
Collapse
|
11
|
Limbucci N, Leone G, Renieri L, Nappini S, Cagnazzo F, Laiso A, Muto M, Mangiafico S. Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas. Neurosurgery 2020; 86:S85-S94. [PMID: 31838532 PMCID: PMC6911737 DOI: 10.1093/neuros/nyz334] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
Flow diverter devices have gained wide acceptance for the treatment of unruptured intracranial aneurysms. Most studies are based on the treatment of large aneurysms harboring on the carotid syphon. However, during the last years the “off-label” use of these stents has widely grown up even if not supported by randomized studies. This review examines the relevant literature concerning “off-label” indications for flow diverter devices, such as for distal aneurysms, bifurcation aneurysms, small aneurysms, recurrent aneurysms, and direct carotid cavernous fistulas.
Collapse
Affiliation(s)
- Nicola Limbucci
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Giuseppe Leone
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy.,Department of Neuroradiology, Cardarelli Hospital, Naples, Italy
| | - Leonardo Renieri
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Sergio Nappini
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Federico Cagnazzo
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Antonio Laiso
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Mario Muto
- Department of Neuroradiology, Cardarelli Hospital, Naples, Italy
| | | |
Collapse
|
12
|
Ma L, Feng H, Yan S, Xu JC, Tan HQ, Fang C. Endovascular Treatment of Complex Vascular Diseases of the Internal Carotid Artery Using the Willis Covered Stent: Preliminary Experience and Technical Considerations. Front Neurol 2020; 11:554988. [PMID: 33192988 PMCID: PMC7658537 DOI: 10.3389/fneur.2020.554988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose: The Willis covered stent (WCS) is used to treat complex vascular diseases of the internal carotid artery; however, its performance requires further investigation. This study aimed to present our single-center clinical results and experience of endovascular repair of complex vascular diseases of the internal carotid artery using the WCS. Methods: Patients who presented with complex vascular diseases of the internal carotid artery and who were treated with the WCS from December 2013 to September 2018 were retrospectively reviewed. Procedural results, perioperative complications, incidence of endoleak, and follow-up outcomes were analyzed. Results: Sixty-five patients were enrolled. A total of 25 large aneurysms, 10 pseudoaneurysms, 14 blood blister-like aneurysms, 11 carotid–cavernous fistulas, and 5 surgical injuries were assessed. WCS placement was successful in all patients. Immediate angiography showed that complete repair of the target artery was achieved in 56 patients (86.2%). Endoleak was observed in nine patients, including seven type I endoleaks and two type II endoleaks. Occlusion of a side-branch vessel occurred in four patients. Acute in-stent thrombosis occurred in one patient. No ischemic or hemorrhagic events or other complications developed during the perioperative and follow-up periods. Angiographic follow-up (mean duration, 12 ± 3.29 months) was performed in 60 patients and showed complete target artery repair in 58 patients, and asymptomatic mild to moderate in-stent stenosis was observed in four patients. Slight endoleak persisted in two patients without enlargement or rupture of the residual lumen. Conclusion: WCS implantation is safe, feasible, and efficacious for endovascular repair in patients with complex vascular diseases of the internal carotid artery, showing excellent short-term target artery patency and clinical outcomes.
Collapse
Affiliation(s)
- Lin Ma
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao Feng
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuo Yan
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ji-Chong Xu
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua-Qiao Tan
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun Fang
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
13
|
Thohar Arifin M, Ali Akbar M, Illyasa W, Tsaniadi Prihastomo K. Neuro-Endovascular Intervention in Traumatic Carotico-Cavernous Fistulae: A Single-Center Experience. Int J Gen Med 2020; 13:917-925. [PMID: 33116784 PMCID: PMC7585868 DOI: 10.2147/ijgm.s273603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/17/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of this research was to describe a single-center practical experience in the management of traumatic carotid cavernous fistula (CCF). Methods There were a total of 31 patients between January 2005 and December 2019 with post-traumatic carotid cavernous sinus fistula (tCCF) who underwent treatment. We classified them into 2 types according to the flow of the CCF: patients with high flow CCF and patients with low flow CCF. Results Angiography revealed the high flow types on 21 patients (67.7%), the mean of patients ages are 31.5 years. Onyx embolization was performed in 1 patient (4.76%), transarterial balloon embolization was carried out in 10 patients (47.61%), transarterial coiling in 3 (14.28%) patients while 5 (28.8%) patients underwent transvenous routes to insert the coil and 2 patients (9.52%) were treated conservatively. Complete occlusion was achieved on all patients with coiling whereas the other treatment experiences the reducing flow of the fistula. We obtained 10 patients (32.2%) with a mean of 40.3 years as low flow type CCF. The patients with the low flow type mostly treated conservatively, because their symptoms were acceptable and intermittent. Conclusion The ballooning currently became the more affordable treatment in our center. Balloon embolization was recommended for medium- and large-size fistula. The coils should be recommended for small-size fistula. In some cases occlusion of the fistula cannot be obtained using the detachable balloon, a coil can be used to occlude the cavernous sinus via trans arterial or trans venous access. If the fistula failed to be treated in traditional ways using balloons or coils, occlusion of the parent vessels could be another option.
Collapse
Affiliation(s)
- Muhamad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Mohammad Ali Akbar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Widianto Illyasa
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | | |
Collapse
|
14
|
Sharma DP, Kannath SK, Singh G, Rajan JE. Shunt Site Localization of Direct Carotid-Cavernous Fistula Using 3D Rotational Angiography-Utility of Broken-Rim Sign. World Neurosurg 2020; 144:e376-e379. [PMID: 32890847 DOI: 10.1016/j.wneu.2020.08.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Direct carotid-cavernous fistulas (DCCF) develop due to breach in the integrity of the wall of the internal carotid artery, and its localization can sometimes be difficult due to rapid high flow shunts. We hypothesized that 3D rotational angiography could locate the fistula site accurately, where an interrupted rim of the carotid wall would be silhouetted against opacified vascular structures. This finding was described as a broken-rim sign, and in this study, we assessed the utility of this sign in the localization of the shunt point of DCCF. METHODS Retrospective analysis of 15 cases of DCCF was performed, and the rent was characterized based on the broken-rim sign. Two observers independently evaluated the results and compared them against the intraoperative observations. RESULTS The broken-rim sign was identified and correlated with the actual fistula site in 86.6% and 100% of patients by observers 1 and 2, respectively. The inter-rater agreement was 0.87 (P < 0.001). Misinterpretation was made in 2 patients by 1 observer, due to poor contrast opacification of the vascular structures secondary to very rapid shunting and mild movement artifacts. CONCLUSIONS Our study highlights the role of 3D rotational angiogram and analysis of the carotid wall in the localization of the shunt site in DCCF. The broken-rim sign accurately points to the location of the fistula.
Collapse
Affiliation(s)
- Dev Prakash Sharma
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute For Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kumar Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute For Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - Gurpreet Singh
- Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute For Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayadevan Enakshy Rajan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute For Medical Sciences and Technology, Trivandrum, Kerala, India
| |
Collapse
|
15
|
Comaneci-Assisted Coiling Embolization of a Posttraumatic Carotid-Cavernous Fistula. World Neurosurg 2020; 141:166-170. [DOI: 10.1016/j.wneu.2020.05.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022]
|
16
|
Yan P, Zhang Y, Ma C, Liang F, Zhu H, Jiang C. Application of the Willis Covered Stent in the treatment of intracranial unruptured aneurysms in internal carotid artery: A retrospective single-center experience. J Clin Neurosci 2020; 78:222-227. [DOI: 10.1016/j.jocn.2020.04.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/04/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
|
17
|
Chang S, Young Chung S, Sung Lee D, Suk Park K. Treatment of Carotid Cavernous Fistula Presenting with Contralateral Exophthalmos: Several Experiences of Graft Stent. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:238-242. [PMID: 37501698 PMCID: PMC10370652 DOI: 10.5797/jnet.cr.2019-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/10/2020] [Indexed: 07/29/2023]
Abstract
Objective Graft stent for carotid cavernous fistula (CCF) is known to be a useful treatment. Here, we report our experiences of treatment with graft stents for CCFs. Case Presentations From 2015 through 2018, six patients underwent graft stent placement for CCF occlusion. Clinical and angiographic data were retrospectively reviewed. Access and deployment of a graft stent was successful in all patients and complete occlusion immediately after the procedure or 3-month follow-up angiography. Conclusion Graft stents should be considered as an alternative option of treating CCFs and preserving the parent artery by arterial wall reconstruction especially in patients with a fistula that cannot be successfully occluded with detachable balloons or coils.
Collapse
Affiliation(s)
- Sehun Chang
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Seung Young Chung
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Do Sung Lee
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Ki Suk Park
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| |
Collapse
|
18
|
Deng Q, Feng WF. Efficacy of pipeline endovascular device and Willis stent graft in the treatment of traumatic pseudo intracranial aneurysms. J Interv Med 2020; 3:45-48. [PMID: 34805906 PMCID: PMC8562160 DOI: 10.1016/j.jimed.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the advantages and effects of pipeline embolization device (PED) or Willis stent, in treating traumatic pseudoaneurysms. Traumatic pseudo intracranial aneurysms (TPIA) can be caused by either direct trauma or iatrogenic injuries, usually caused by direct arterial wall injury or shear due to acceleration. We describe a series of patients with TPIA who received a PED or Willis stent. MATERIALS AND METHODS Retrospective analysis was performed on nine patients with TPIA admitted to the southern hospital of Southern Medical University from December 2017 to June 2019, of whom four were treated with PED and five were implanted with six Willis covered stents. The occlusive rate and complication in the two kinds of stents were compared by postoperative follow-up and modified rankin score (MRS). RESULTS After the implantation of PED, four patients showed an immediate stagnation of blood flow or a decreased filling in aneurysms, three out of four patients exhibited complete occlusion, and the remaining patient had nearly complete occlusion. Four out of five cases of Willis stent implantation were associated with immediate complete occlusion of aneurysms, and the modified rankin score of these patients ranged from 0 to 1. One patient died of unassociated complications. CONCLUSION For different types of TPIA in the internal carotid artery (ICA), PED and Willis stents provide significant advantages in treatment, with fewer postoperative complications and prognosis well.
Collapse
Affiliation(s)
- Qiao Deng
- Department of Neurosurgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| | - Wen feng Feng
- Department of Neurosurgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| |
Collapse
|
19
|
Niu Y, Chen T, Tang J, Jiang Z, Zhu G, Chen Z. Detachable balloon embolization as the preferred treatment option for traumatic carotid-cavernous sinus fistula? Interv Neuroradiol 2019; 26:90-98. [PMID: 31451026 DOI: 10.1177/1591019919871849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The purpose of the study was to investigate the treatments and outcomes of patients with traumatic carotid-cavernous sinus fistula (TCCF). METHODS All patients diagnosed with TCCF at our institution from January 2013 to December 2018 and meeting the inclusion/exclusion criteria were included in the study. RESULTS A total of 24 patients were included in this study. Of them, 21 (87.5%) were treated with detachable balloon embolization, 1 (4%) with coil embolization, 1 (4%) with balloon-assisted coil embolization, and 1 (4%) with balloon-assisted coil and glue embolization. Among the 21 patients treated with detachable balloon embolization, 10 underwent double-balloon technique embolization including double-detachable balloon embolization (n = 6) and balloon-assisted detachable balloon embolization (n = 4). The fistulas in 17 patients (17/21, 81%) were successfully occluded after the first attempt of detachable balloon embolization, while those in the remaining 4 patients were occluded after a second surgery due to TCCF recurrence or pseudoaneurysm development. Preservation of the internal carotid artery (ICA) was observed in 19 cases after the first treatment by detachable balloon embolization (19/21, 90.4%). ICA was occluded in the remaining two patients, as revealed by a complete angiographic evaluation of the circle of Willis. All patients achieved complete resolution of ocular and orbital manifestations as well as pulsatile bruit, except for three patients whose oculomotorius and/or abducens remained paralyzed during the follow-up period. CONCLUSION Although several endovascular treatment options are available for TCCF, the detachable balloon embolization is still the preferred method of TCCF, as evidenced in our study. Furthermore, double balloon technique, an improvement upon the conventional detachable balloon embolization, is extremely safe and can effectively treat patients with refractory TCCF.
Collapse
Affiliation(s)
- Yin Niu
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Tunan Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jun Tang
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - ZhouYang Jiang
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Gang Zhu
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| |
Collapse
|
20
|
Ghorbani M, Hejazian SE, Dastmalchi A, Chavoshinejad M, Asaadi S. Orbital Compartment Syndrome Secondary to Direct Carotid Cavernous Fistula After Carotid Cavernous Aneurysm Rupture: Case Report and Review of Literature. World Neurosurg 2019; 133:409-412. [PMID: 31421298 DOI: 10.1016/j.wneu.2019.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid cavernous aneurysm (CCA) rupture is rare. However, it can result in various complications such as carotid cavernous fistula (CCF), epistaxis, spontaneous thrombosis, and subarachnoid hemorrhage. CASE DESCRIPTION We report a 65-year-old woman with a history of uncontrolled diabetes who was referred with complaints of acute headache, diplopia, proptosis, and chemosis. Ophthalmic examination revealed elevated intraocular pressure in the right eye, optic disk edema, and retinal venous congestion. Canthotomy was performed based on a diagnosis of orbital compartment syndrome (OCS). Further imaging revealed a dilated superior ophthalmic vein and cavernous sinus, as well as swelling of the extraocular muscles in the right eye. Digital subtraction angiography revealed the fistulous connection between the cavernous part of the internal carotid and cavernous sinus (direct CCF) due to the large ruptured CCA, resulting in retrograde flow through the superior and inferior ophthalmic veins. Successful endovascular coiling of the aneurysm resulted in complete occlusion of the fistula. Postintervention ophthalmic examination demonstrated progressive improvement of ophthalmic signs and symptoms; however, the patient's right eye remained sightless. CONCLUSIONS In patients with clinical manifestation of OCS with no history of any predisposing risk factors, diagnosis of ruptured cavernous sinus aneurysm and resulting direct CCF should be considered. In such cases, emergent imaging along with early endovascular intervention can resolve OCS and prevent permanent ocular injury and vision loss.
Collapse
Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran
| | | | - Alireza Dastmalchi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran
| | - Mehdi Chavoshinejad
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran
| | - Sina Asaadi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran; Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
21
|
Liu Y, Yang HF, Xiong ZY, Zheng J, Liu CY, Zhao HY, Hu XB. Efficacy and Safety of Willis Covered Stent for Treatment of Complex Vascular Diseases of the Internal Carotid Artery. Ann Vasc Surg 2019; 61:203-211. [PMID: 31381999 DOI: 10.1016/j.avsg.2019.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/03/2019] [Accepted: 05/04/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Willis covered stents are used in clinical practice for some complex cerebrovascular diseases. However, the performance of the Willis covered stent requires further investigation. In this study, we investigate the safety and efficacy of Willis covered stents for the treatment of complex vascular diseases of the internal carotid artery (ICA). METHODS Thirteen patients with complex ICA diseases treated with the Willis covered stent system at our institution from October 2016 to January 2018 were analyzed retrospectively. Follow-up observation and digital subtraction angiography (DSA) examination were conducted at about 6-10 months after the treatment. RESULTS The complex vascular diseases of the ICA were successfully treated in 12 patients. The technical success rate was 92.3%. Pathologically, 13 lesions included blood blister-like aneurysm (n = 7), traumatic pseudoaneurysm (n = 1), traumatic carotid artery rupture (n = 1), and aneurysm with arteriovenous fistula (n = 4). Thirteen patients with complex vascular diseases of the ICA were treated with 15 Willis covered stents. The release sites of Willis covered stents were the C7 (n = 2), C6 (n = 1), C5 and/or C4 (n = 9), and the C2 (n = 3) segment of the ICA. DSA performed immediately after stent deployment revealed that complete occlusion of the lesion was achieved in 11 patients and endoleak was observed in 2 patients. Of the 11 patients, postoperative DSA examination indicated that the lesions were occluded completely. Among 2 patients, who had a second stent implantation at the break of the ICA, the traumatic ICA rupture was essentially completely obstructed in 1 patient. The endoleak remained in 1 patient with carotid cavernous sinus fistula because the placement of the second stent system was difficult with his ICA tortuosity. No recurrence of aneurysms, hemorrhagia, and other lesions was observed, and the patients' parent arteries were patent without stenosis. No procedure-related complications or deaths occurred during follow-up. CONCLUSIONS For the treatment of complex vascular diseases in the ICA, Willis covered stent implantation is safe and effective. However, longer follow-up, large-sample controlled studies, and multicenter studies are needed for further confirmation.
Collapse
Affiliation(s)
- Yang Liu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Feng Yang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Yong Xiong
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Zheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang-Ya Liu
- Department of Neurology, HuBei Provincial Hospital of TCM, HuBei University of Chinese Medicine, Wuhan, China
| | - Hong-Yang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xue-Bin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
22
|
Liu LX, Lim J, Zhang CW, Lin S, Wu C, Wang T, Xie XD, Zhou LX, Wang CH. Application of the Willis Covered Stent in the Treatment of Carotid-Cavernous Fistula: A Single-Center Experience. World Neurosurg 2018; 122:e390-e398. [PMID: 30352308 DOI: 10.1016/j.wneu.2018.10.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of the present study was to describe our single-institutional experience of treating direct carotid-cavernous fistulas (DCCFs) with Willis covered stents (WCSs). METHODS Of a total of 31 DCCFs, 10 were treated with WCSs (Microport, Shanghai, China) at West China Hospital from January 2015 to December 2016. The indications for treatment, perioperative findings, and postoperative and follow-up results were collected and analyzed. RESULTS All 10 patients had successful deployment of WCSs. Complete exclusion of the fistula was achieved in 6 patients immediately after deployment of 1 stent. Endoleak was observed in 4 patients (patients 2, 4, 5, and 9). Thus, repeat dilation of the stent with greater pressure was performed, which resolved the endoleak in 2 patients (patients 2 and 9). The endoleak of the other 2 patients persisted after repeat dilation of the balloon. Hence, a second stent was deployed in these 2 patients (patients 4 and 5), which eliminated the endoleak in patient 4. However, patient 5 continued to have a minimal endoleak. Nine patients had fistulas successfully occluded by WCSs during the follow-up period. One patient experienced recurrence of a DCCF at the 10-day follow-up point. We chose coil embolization to address this DCCF. No stenosis of the internal carotid artery or DCCF recurrence, except that in the abovementioned patient, was observed. CONCLUSIONS WCS was proved to be an alternative treatment method for complex DCCFs through reconstruction and preservation of the internal carotid artery. Our study also confirmed the safety, efficacy, and midterm durability of WCSs for complex DCCFs without any serious delayed complications.
Collapse
Affiliation(s)
- Lun-Xin Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Jaims Lim
- Department of Neurological Surgery, University of Buffalo, Buffalo, New York, USA
| | - Chang-Wei Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Sen Lin
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Cong Wu
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Ting Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Xiao-Dong Xie
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Liang-Xue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Chao-Hua Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China.
| |
Collapse
|
23
|
Ogilvy CS, Motiei-Langroudi R, Ghorbani M, Griessenauer CJ, Alturki AY, Thomas AJ. Flow Diverters as Useful Adjunct to Traditional Endovascular Techniques in Treatment of Direct Carotid-Cavernous Fistulas. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
24
|
Abstract
Carotid-cavernous fistula was one of the first intracranial vascular lesions to be recognized. This paper focuses on the historical progression of our understanding of the condition and its symptomatology-from the initial hypothesis of ophthalmic artery aneurysm as the cause of pulsating exophthalmos to the recognition and acceptance of fistulas between the carotid arterial system and cavernous sinus as the true etiology. The authors also discuss the advancements in treatment from Benjamin Travers' early common carotid ligation and wooden compression methods to today's endovascular approaches.
Collapse
Affiliation(s)
| | - Ghaith Habboub
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Peter A Rasmussen
- Cerebrovascular Center and.,Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
25
|
Wang W, Li MH, Li YD, Gu BX, Lu HT. Reconstruction of the Internal Carotid Artery After Treatment of Complex Traumatic Direct Carotid-Cavernous Fistulas With the Willis Covered Stent. Neurosurgery 2016; 79:794-805. [DOI: 10.1227/neu.0000000000001266] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Endovascular treatment of complex traumatic direct carotid-cavernous fistulas (TDCCFs) is a challenge.
OBJECTIVE:
To evaluate the long-term efficacy of the Willis covered stent in endovascular treatment of complex TDCCFs, focusing on reconstruction and preservation of the internal carotid artery.
METHODS:
During the past 8 years, 25 patients with 27 TDCCFs who previously had unsuccessful treatment of fistulas with detachable balloons received endovascular treatment with Willis covered stents. The efficacy, complications, in-stent stenosis, angiographic, and clinical follow-up results were evaluated retrospectively between 6 and 88 months (mean, 43.8 months) after the stent placement.
RESULTS:
The technical success rate of stenting placement was 100%. Forty-four Willis covered stents were implanted into the target artery of 27 TDCCFs. Complete exclusion was achieved in 16 patients with 17 TDCCFs immediately after the stent placement, with transient endoleaks in 10 TDCCFs. Redilation was performed in 6 TDCCFs, and additional stents were implanted in the other 4 TDCCFs for endoleak exclusion. The initial angiographic results showed complete exclusion of fistulas with preservation of the internal carotid artery in 24 patients with 26 TDCCFs. One patient in whom complete occlusion initially was achieved subsequently experienced a delayed endoleak, which required placement of an additional stent. The angiographic follow-up results (mean, 30.3 months) demonstrated complete exclusion in all 27 TDCCFs, with patency of internal carotid artery in 23 patients. The clinical follow-up demonstrated a full recovery in 23 patients and improvement in 2 patients.
CONCLUSION:
The use of Willis covered stents was confirmed to be effective, safe, and a curative approach for endovascular treatment of complex TDCCFs and internal carotid artery reconstruction.
Collapse
Affiliation(s)
- Wu Wang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ming-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yong-Dong Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bin-Xian Gu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hai-Tao Lu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
26
|
Baek JW, Kim ST, Lee YS, Jeong YG, Jeong HW, Baek JW, Seo JH. Recurrent Carotid Cavernous Fistula Originating from a Giant Cerebral Aneurysm after Placement of a Covered Stent. J Cerebrovasc Endovasc Neurosurg 2016; 18:306-314. [PMID: 27847780 PMCID: PMC5104861 DOI: 10.7461/jcen.2016.18.3.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 11/23/2022] Open
Abstract
We report the case of a recurrent carotid cavernous fistula (CCF) originating from a giant cerebral aneurysm (GCA) after placement of a covered stent. A 47-year-old woman presented with sudden onset of severe headache, and left-sided exophthalmos and ptosis. Cerebral angiography revealed a CCF caused by rupture of a GCA in the cavernous segment of the left internal carotid artery. Two covered stents were placed at the neck of the aneurysm. The neurological symptoms improved at first, but were aggravated in the 6 months following the treatment. Contrast agent endoleak was seen in the distal area of the stent. Even though additional treatments were attempted via an endovascular approach, the CCF could not be cured. However, after trapping the aneurysm using coils and performing superficial temporal artery-middle cerebral artery bypass, the neurological symptoms improved. In cases of recurrent CCF originating from a GCA after placement of a covered stent, it is possible to treat the CCF by endovascular trapping and surgical bypass.
Collapse
Affiliation(s)
- Jung Wook Baek
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Young Seo Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Young-Gyun Jeong
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Hae Woong Jeong
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Jin Wook Baek
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Jung Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| |
Collapse
|
27
|
Demartini Z, Liebert F, Gatto LAM, Jung TS, Rocha C, Santos AMB, Koppe GL. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation. Case Rep Ophthalmol 2015; 6:482-7. [PMID: 26955353 PMCID: PMC4777947 DOI: 10.1159/000443141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.
Collapse
|
28
|
Hassan T, Rashad S, Aziz W, Sultan A, Ibrahim T. Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience. J Stroke Cerebrovasc Dis 2015; 24:2824-38. [PMID: 26409721 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/10/2015] [Accepted: 08/14/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cavernous sinus (CS) fistulas are classified into traumatic and spontaneous. Traumatic carotid-cavernous fistulas (CCFs) are usually direct internal carotid artery (ICA) high-flow fistulas; whereas spontaneous CCFs are usually dural, low-flow fistulas and generally possess less severe symptoms than direct carotid-cavernous fistulas. METHODS This study involved 34 patients who were classified into 2 groups: Group A included 26 patients with direct carotid-cavernous fistula; and Group B included 8 patients with indirect dural cavernous fistula. All patients had ocular manifestations. One patient had subarachnoid hemorrhage. Coils were used alone in 19 cases of direct fistula and in 1 case of dural fistulas. Coils and Onyx (Covidien, Mansfield, MA, USA) were used in 7 cases of direct fistula and in 2 cases of dural fistulas. Onyx alone was used to treat 5 cases with dural fistulas but none of the cases with direct fistulas. Covered stents and coils were used in 2 cases of direct fistulas. RESULTS All patients in both groups showed full recovery of their clinical signs and symptoms. Only 1 procedure-related complication was observed (3%) in which a patient had an embolic event and trigeminal dysesthesia as a result of Onyx reflux through external carotid artery-ICA anastomosis. CONCLUSION Coils are superior solid embolic agents used for the treatment of direct high-flow fistulas, while Onyx is more valuable in dural low-flow CCF. Onyx shortens the procedure time and decreases procedure cost. Onyx injection inside the CS proper through the transarterial or transvenous route may be safer than Onyx injected inside dural arteries supplying the CS. However, more cases are needed to determine this.
Collapse
Affiliation(s)
- Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt.
| | - Sherif Rashad
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Waseem Aziz
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Tamer Ibrahim
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| |
Collapse
|
29
|
Use of Pipeline Embolization Devices for treatment of a direct carotid-cavernous fistula. Acta Neurochir (Wien) 2015; 157:1125-9; discussion 1130. [PMID: 25981434 DOI: 10.1007/s00701-015-2446-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The use of minimally porous endoluminal devices (MPEDs) such as the Pipeline Embolization Device (PED) has been described for the treatment of brain aneurysms. The benefit of using MPEDs to assist embolization of a direct high-flow carotid cavernous fistula resulting from a ruptured cavernous carotid artery aneurysm is not well documented. METHODS We describe our experience with deploying a tailored multidevice PED construct across the cavernous internal carotid artery (ICA) wall defect in combination with transarterial coil embolization using the "jailed microcatheter" technique. RESULTS A 59-year-old woman presented with acute left-sided ophthalmoplegia. Diagnostic cerebral angiography demonstrated a ruptured giant cavernous carotid aneurysm with fistulous outflow via the ipsilateral left superior ophthalmic vein and into the pterygoid venous plexi bilaterally. Via the Marksman microcatheter, a total of three PEDs measuring 4.5 mm × 18 mm, 4.5 mm × 20 mm, and 4.75 mm × 16 mm were telescoped within the ICA across the aneurysm neck. Coiling of the aneurysm fundus and cavernous sinus via the "jailed" Rapidtransit microcatheter was subsequently achieved. A 2-year follow-up digital subtraction angiography (DSA) demonstrated stable obliteration of the aneurysm and the fistula, coincident with complete resolution of the patient's symptoms. CONCLUSIONS Based on our long-term clinical and angiographic results, we advocate that the presented method be a valid treatment option for selected cases.
Collapse
|
30
|
Samaniego EA, Martínez-Galdámez M, Abdo G. Treatment of direct carotid-cavernous fistulas with a double lumen balloon. J Neurointerv Surg 2015; 8:531-5. [PMID: 25878067 DOI: 10.1136/neurintsurg-2015-011695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/26/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the treatment of direct high flow carotid-cavernous sinus fistulas (dCCFs) with the double lumen balloon Scepter C. MATERIALS AND METHODS 7 patients with dCCFs were identified and treated with a double lumen balloon Scepter C. 5 patients had post-traumatic dCCFs and two patients had spontaneous dCCFs due to a ruptured cavernous-carotid aneurysm. The double lumen balloon was used in characterizing the angioarchitecture of the fistula in all patients. The best treatment option was then decided based on the characteristics of the carotid wall tear. Embolization of the cavernous sinus was achieved with coils and injection of Onyx liquid embolic material in three patients and with coils alone in four patients. One patient required stent assisted coiling to reconstruct the internal carotid artery. RESULTS 7 patients with dCCFs were treated with transarterial embolization. All patients had immediate angiographic and clinical cure. The Scepter C balloon was used for balloon assisted coiling and injection of Onyx liquid embolic material. On follow-up, all patients had clinical symptom resolution. CONCLUSIONS The Scepter C balloon is a useful tool for the transarterial treatment of dCCFs.
Collapse
Affiliation(s)
- Edgar A Samaniego
- Departamento de Neuroradiologia Intervencionista, Hospital Eugenio Espejo, Quito, Ecuador
| | - Mario Martínez-Galdámez
- Interventional Neuroradiology, Radiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - German Abdo
- Departamento de Neuroradiologia Intervencionista, Hospital Eugenio Espejo, Quito, Ecuador
| |
Collapse
|
31
|
Li K, Cho YD, Kim KM, Kang HS, Kim JE, Han MH. Covered stents for the endovascular treatment of a direct carotid cavernous fistula : single center experiences with 10 cases. J Korean Neurosurg Soc 2015; 57:12-8. [PMID: 25674338 PMCID: PMC4323499 DOI: 10.3340/jkns.2015.57.1.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/13/2014] [Accepted: 04/15/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Covered stent has been recently reported as an effective alternative treatment for direct carotid cavernous fistulas (DCCFs). The purpose of this study is to describe our experiences with the treatment of DCCF with covered stents and to evaluate whether a covered stent has a potential to be used as the first choice in selected cases. METHODS From February 2009 through July 2013, 10 patients underwent covered stent placement for a DCCF occlusion. Clinical and angiographic data were retrospectively reviewed. RESULTS Covered stent placement was performed for five patients primarily as the first choice and in the other five as an alternative option. Access and deployment of a covered stent was successful in all patients (100%) and total occlusion of the fistula was achieved in nine (90%). Complete occlusion immediately after the procedure was obtained in five patients (50%). Endoleak persisted in five patients and the fistulae were found to be completely occluded by one month control angiography in four. The other patient underwent additional coil embolization by a transvenous approach. Balloon inflation-related arterial dissection during the procedure was noted in two cases; healing was noted at follow-up angiography. One patient suffered an asymptomatic internal carotid artery occlusion noted seven months post-treatment. CONCLUSION Although endoleak is currently a common roadblock, our experience demonstrates that a covered stent has the potential to be used as the first choice in DCCF; this potential is likely to increase as experience with this device accumulates and the materials continue to improve.
Collapse
Affiliation(s)
- Ke Li
- Department of Interventional Radiology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
32
|
Nakagawa S, Murai Y, Wada T, Tateyama K. 4D flow preliminary investigation of a direct carotid cavernous fistula due to a ruptured intracavernous aneurysm. BMJ Case Rep 2015; 2015:bcr-2014-206084. [PMID: 25612750 DOI: 10.1136/bcr-2014-206084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Inadequate information is available about the cerebral blood flow and surgical strategies of a direct aneurysmal carotid cavernous fistula (daCCF). We report a quantitative analysis of flow velocity and volume using preoperative time-resolved phase-contrast MRI (four-dimensional (4D) flow MRI) in a daCCF. This is the first report of 4D flow findings with a daCCF. A 55-year-old woman developed a sudden headache and bruit of the right orbit, and MRI suggested the presence of a daCCF. Quantitative analysis using preoperative 4D flow MRI revealed the flow volume of the right internal carotid artery. The daCCF was successfully treated by high-flow bypass using a radial artery graft and internal carotid artery trapping. Postoperative angiography showed a complete obliteration of the daCCF. Studies to collect data from additional cases are required so that 4D flow findings can be further used in the management of daCCFs.
Collapse
Affiliation(s)
| | - Yasuo Murai
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Takeshi Wada
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Kojiro Tateyama
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
33
|
Harrison JF, Vega RA, Machinis TG, Reavey-Cantwell JF. Multiple unilateral traumatic carotid-cavernous sphenoid sinus fistulas with associated massive epistaxis: a consequence of parkour. Ochsner J 2015; 15:92-96. [PMID: 25829888 PMCID: PMC4365856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Traumatic carotid-cavernous fistulas (CCFs) present the clinician with diagnostic and surgical challenges. Extension of a CCF into the sphenoid sinus presents additional management difficulties. Endovascular interventions using various thrombogenic materials such as balloons, coils, or liquids are effective treatment strategies. Ideally, these techniques are used to obliterate the fistula while maintaining the patency of the parent artery. CASE REPORT We present a rare case of traumatic carotid-cavernous sphenoid sinus fistulas complicated by multiple tears in the internal carotid artery with direct communication to the cavernous and sphenoid sinus. As a result, the patient developed massive epistaxis requiring emergent endovascular intervention. A total of 87 detachable coils were placed into the cavernous and sphenoid sinuses via transarterial and transvenous routes in a staged procedure, resulting in complete obliteration of the patient's multiple fistulas. CONCLUSION To our knowledge, this is the first reported case of multiple fistulous tears in the internal carotid artery with extension to the cavernous and sphenoid sinus. This report emphasizes the importance of early diagnosis and neurosurgical intervention.
Collapse
Affiliation(s)
- Jason F. Harrison
- Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA
| | - Rafael A. Vega
- Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA
| | - Theofilos G. Machinis
- Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA
| | - John F. Reavey-Cantwell
- Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA
| |
Collapse
|
34
|
Lu X, Hussain M, Ni L, Huang Q, Zhou F, Gu Z, Chen J, Ding Y, Xu F. A comparison of different transarterial embolization techniques for direct carotid cavernous fistulas: a single center experience in 32 patients. JOURNAL OF VASCULAR AND INTERVENTIONAL NEUROLOGY 2014; 7:35-47. [PMID: 25566340 PMCID: PMC4280878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Transarterial treatment of direct carotid cavernous fistulas (DCCF) via embolic materials has been well documented. This study reports, validates, and compares with existing literature our experience treating DCCFs via endovascular approaches by using detachable balloons, coils, and covered stents. METHODS Between June 2006 to October 2011, 32 patients (21 male, 11 female) with 32 DCCFs (30 traumatic, 2 spontaneous cavernous ICA aneurysms) were embolized endovascularly. Followup was performed for at least 6 months. RESULTS Among the 32 DCCFs, 21 (65.6%) were embolized using detachable balloons, eight (25.0%) with coils, one (3.1%) with balloons and coils, and two (6.3%) with covered stents. Complete DCCF obliteration was achieved in 31 (96.9%) cases. One fistula failed to respond due to premature balloon detachment. Intracranial bruit in 31 (100%) chemosis and exophthalmos in 28 (100%) cases resolved after embolization. Visual acuity and oculomotor palsy improved in 18 (90%) and 18 (69.2%) cases, respectively. There was no evidence of DCCF recurrence. Thirteen DCCFs were followed up by MRI and five by DSA. In these cases, four (4/13, 30.8%) balloon-embolized DCCFs showed pseudoaneurysms. Three patients were asymptomatic; one had minor left oculomotor palsy. CONCLUSIONS Our results correlate and reinforce literature regarding endovascular treatment of DCCFs. Application of Transarterial embolization with detachable balloons, despite extensive use has been decreasing. Coil embolization is an effective and safe alternative for treatment, especially when balloon embolization fails. Covered stent placement may be used as another alternative for selected cases.
Collapse
Affiliation(s)
- Xiaojian Lu
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China
| | - Mohammed Hussain
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
| | - Lanchun Ni
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China
| | - Qinfeng Huang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China
| | - Fei Zhou
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China
| | - Zhikai Gu
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China
| | - Jian Chen
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
| | - Feng Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Shanghai 200040, China
| |
Collapse
|
35
|
Kim BM, Jeon P, Kim DJ, Kim DI, Suh SH, Park KY. Jostent covered stent placement for emergency reconstruction of a ruptured internal carotid artery during or after transsphenoidal surgery. J Neurosurg 2014; 122:1223-8. [PMID: 25415067 DOI: 10.3171/2014.10.jns14328] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Internal carotid artery (ICA) rupture during transsphenoidal surgery (TSS) is an extremely difficult complication to treat. This study aimed to evaluate the immediate and long-term outcomes of covered stent placement for emergency reconstruction of ruptured ICAs during or after TSS. METHODS Seven patients underwent covered stent placement for emergency reconstruction of a ruptured ICA during or after TSS. The safety and effectiveness of covered stent placement for emergency reconstruction of ruptured ICAs were retrospectively analyzed. RESULTS Pretreatment angiography showed active bleeding in 6 patients (5 intraoperative and 1 postoperative) and a pseudoaneurysm in 1 patient. Of the 6 patients with active bleeding, 5 were treated with a successive operation to control active bleeding. The other patient was treated just after cardiopulmonary resuscitation due to massive nasal bleeding 20 days after revision of TSS. All active bleeding was controlled immediately after covered stent insertion in these 6 patients. One patient showed a gap between the covered stent and ICA wall without active bleeding 30 minutes after glycoprotein IIb/IIIa inhibitor administration due to in-stent thrombosis. The gap was occluded with coil embolization after completion of the temporarily suspended TSS. The seventh patient, whose ICA tear was treated with surgical suture, underwent covered stent placement for a pseudoaneurysm detected on postoperative Day 2. During a mean follow-up period of 46 months (range 12-85 months), all patients had excellent outcomes (modified Rankin Scale score of 0). All the stented ICAs were patent on vascular imaging follow-up at a mean of 34 months (range 12-85 months). CONCLUSIONS Covered stents appear to be a safe and effective option for emergency reconstruction of ruptured ICAs during or after TSS.
Collapse
|
36
|
Mortimer AM, Klimczak K, Nelson RJ, Renowden SA. Endovascular Management of Cavernous Internal Carotid Artery Pseudoaneurysms Following Transsphenoidal Surgery: A Report of Two Cases and Review of the Literature. Clin Neuroradiol 2014; 25:295-300. [PMID: 25139269 DOI: 10.1007/s00062-014-0332-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/04/2014] [Indexed: 11/26/2022]
Affiliation(s)
- A M Mortimer
- Department of Neuroradiology, Southmead Hospital, North Bristol NHS Trust, BS10 5NB, Bristol, Southmead Road, UK,
| | | | | | | |
Collapse
|
37
|
Zanaty M, Chalouhi N, Tjoumakaris SI, Hasan D, Rosenwasser RH, Jabbour P. Endovascular treatment of carotid-cavernous fistulas. Neurosurg Clin N Am 2014; 25:551-63. [PMID: 24994090 DOI: 10.1016/j.nec.2014.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Endovascular management has become the treatment of choice for carotid-cavernous fistulas regardless of the fistula type. The endovascular method offers numerous options that render it capable of treating each fistula type by choosing an adequate technique. This advantage along with the advancement in the field has led to fewer complications with higher success rate.
Collapse
Affiliation(s)
- Mario Zanaty
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Nohra Chalouhi
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Stavropaula I Tjoumakaris
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Robert H Rosenwasser
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA; Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
| |
Collapse
|
38
|
Kim HK, Youn SW, Lee J. Quantitative Measurements of Cerebral Circulation in Spontaneously Regressing Traumatic Carotid-Cavernous Sinus Fistula with Velocity-Encoded Magnetic Resonance Imaging. Clin Neuroradiol 2014; 25:187-91. [PMID: 24718996 DOI: 10.1007/s00062-014-0300-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ho Kyun Kim
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | | |
Collapse
|
39
|
Andrade G, Ponte De Souza ML, Marques R, Silva JL, Abath C, Azevedo-Filho HRC. Endovascular treatment of traumatic carotid cavernous fistula with balloon-assisted sinus coiling. A technical description and initial results. Interv Neuroradiol 2013; 19:445-54. [PMID: 24355148 PMCID: PMC3902743 DOI: 10.1177/159101991301900407] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/12/2013] [Indexed: 11/16/2022] Open
Abstract
This study aimed to propose an alternative treatment for carotid cavernous fistula (CCF) using the balloon-assisted sinus coiling (BASC) technique and to describe this procedure in detail. Under general anesthesia, we performed the BASC procedure to treat five patients with traumatic CCF. Percutaneous access was obtained via the right femoral artery, and a 7F sheath was inserted, or alternatively, a bifemoral 6F approach was accomplished. A microcatheter was inserted into the cavernous sinus over a 0.014-inch microwire through the fistulous point; the microcatheter was placed distal from the fistula point, and a "U-turn" maneuver was performed. Through the same carotid access, a compliant balloon was advanced to cross the point of the fistula and cover the whole carotid tear. Large coils were inserted using the microcatheter in the cavernous sinus. Coils filled the adjacent cavernous sinus, respecting the balloon. Immediate complete angiographic resolution was achieved, and an early angiographic control (mean = 2.6 months) indicated complete stability without recanalization. The clinical follow-up has been uneventful without any recurrence (mean = 15.2 months). An endovascular approach is optimal for direct CCF. Because the detachable balloon has been withdrawn from the market, covered stenting requires antiplatelet therapy and its patency is unconfirmed, but cavernous sinus coiling remains an excellent treatment option. Currently, there is no detailed description of the BASC procedure. We provide detailed angiograms with suitable descriptions of the exact fistula point, and venous drainage pathways. Familiarity with these devices makes this technique effective, easy and safe.
Collapse
Affiliation(s)
- Gustavo Andrade
- Interventional Neuroradiology, ANGIORAD-IMIP; Recife PE, Brazil - Department of Neurosurgery, Hospital da Restauração; Recife PE, Brazil -
| | | | | | | | | | | |
Collapse
|
40
|
Ducruet AF, Albuquerque FC, Crowley RW, McDougall CG. The Evolution of Endovascular Treatment of Carotid Cavernous Fistulas: A Single-Center Experience. World Neurosurg 2013; 80:538-48. [DOI: 10.1016/j.wneu.2013.02.033] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
|
41
|
Piazza P, Di Lella F, Bacciu A, Di Trapani G, Ait Mimoune H, Sanna M. Preoperative Protective Stenting of the Internal Carotid Artery in the Management of Complex Head and Neck Paragangliomas: Long-Term Results. Audiol Neurootol 2013; 18:345-52. [DOI: 10.1159/000354158] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022] Open
|
42
|
De Renzis A, Nappini S, Consoli A, Renieri L, Limbucci N, Rosi A, Vignoli C, Pellicanò G, Mangiafico S. Balloon-assisted coiling of the cavernous sinus to treat direct carotid cavernous fistula. A single center experience of 13 consecutive patients. Interv Neuroradiol 2013; 19:344-52. [PMID: 24070084 DOI: 10.1177/159101991301900312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/28/2013] [Indexed: 11/16/2022] Open
Abstract
This study evaluated clinical and neuroradiological results in 13 consecutive patients with spontaneous and traumatic direct carotid cavernous fistulas treated at our center between January 2006 and September 2012. All patients were treated by coiling of the cavernous sinus. Coiling was always performed while a semi-compliant non-detachable balloon was temporarily inflated in the internal carotid artery. This technique (balloon-assisted coiling) permitted a clear visualization of the fistula, facilitated coil positioning and protected the patency of the artery. All patients' clinical data and radiological examinations were reviewed; nine patients underwent radiological and clinical follow-up, with a mean duration of 3.8 years (range: six months-six years). Overall results at discharge showed a complete occlusion of the fistula in seven patients (7/13, 54%) and a resolution of symptoms in eight patients (8/12, 67%). Radiological follow-up showed complete occlusion of the fistula in all patients (9/9, 100%) and clinical follow-up showed a resolution of symptoms in eight patients (8/9, 89%) and persistent symptoms in one (1/9, 11%). No procedure-related complications occurred. Balloon-assisted coiling of the cavernous sinus for the treatment of direct carotid cavernous fistulas proved an effective and safe technique, both in angiographic and clinical terms, and may be considered a technical improvement.
Collapse
Affiliation(s)
- Alioscia De Renzis
- Department of Radiology, Careggi University Hospital; Florence, Italy - E-mail:
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Ramalingaiah AH, Prasad C, Sabharwal PS, Saini J, Pandey P. Transarterial treatment of direct carotico-cavernous fistulas with coils and Onyx. Neuroradiology 2013; 55:1213-20. [PMID: 23828324 DOI: 10.1007/s00234-013-1224-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the role of combination of liquid embolic agent ethylene vinyl alcohol copolymer (Onyx) and detachable coils in the treatment of direct carotico-cavernous fistulas (CCFs). METHODS We prospectively collected clinical and radiological data of all patients who underwent embolization of direct CCFs at our institution over a period of 21 months. The clinical parameters, angioarchitecture, presence of cortical venous reflux, volume of Onyx used, number of coils used, extent of embolization and complications were recorded. RESULTS A total of 21 consecutive patients (18 men and 3 women, 14 to 48 years) with direct CCF underwent embolization with a combination of coils and Onyx. Embolization was done through the arterial route in all cases. Complete obliteration of the fistula was achieved in 19 of 21 cases. Cast embolization in middle cerebral artery occurred in one patient; however, the cast was completely retrieved with Solitaire device, and the patient did not have any neurological deficit. All completely treated patients reported relief of symptoms at varying intervals. At 6-month follow-up, none of the patients with complete occlusion of the fistula showed any recurrence. CONCLUSION The adjuvant use of Onyx with detachable coils in direct CCF through the arterial route is a safe and effective method for embolization with immediate and complete occlusion of the fistula. To the best of our knowledge, this is the first case series of demonstration of arterial use of Onyx with coils in the treatment of direct CCFs.
Collapse
Affiliation(s)
- Arvinda Hanumanthapura Ramalingaiah
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India,
| | | | | | | | | |
Collapse
|
44
|
Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of carotid cavernous sinus fistula: A systematic review. World J Radiol 2013; 5:143-155. [PMID: 23671750 PMCID: PMC3647206 DOI: 10.4329/wjr.v5.i4.143] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/06/2013] [Indexed: 02/06/2023] Open
Abstract
Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.
Collapse
|
45
|
He XH, Li WT, Peng WJ, Lu JP, Liu Q, Zhao R. Endovascular Treatment of Posttraumatic Carotid-Cavernous Fistulas and Pseudoaneurysms with Covered Stents. J Neuroimaging 2013; 24:287-91. [PMID: 23621764 DOI: 10.1111/jon.12023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/28/2012] [Accepted: 01/15/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Xin-Hong He
- Department of Radiology; Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Shanghai China
- Department of Radiology; Changhai Hospital, The Second Military Medical University; Shanghai China
| | - Wen-Tao Li
- Department of Radiology; Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Shanghai China
| | - Wei-Jun Peng
- Department of Radiology; Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Shanghai China
- Department of Radiology; Changhai Hospital, The Second Military Medical University; Shanghai China
| | - Jian-Ping Lu
- Department of Radiology; Changhai Hospital, The Second Military Medical University; Shanghai China
| | - Qi Liu
- Department of Radiology; Changhai Hospital, The Second Military Medical University; Shanghai China
| | - Rui Zhao
- Department of Neurosurgery; Changhai Hospital, The Second Military Medical University; Shanghai China
| |
Collapse
|
46
|
Comparison of covered stents with detachable balloons for treatment of posttraumatic carotid-cavernous fistulas. J Clin Neurosci 2013; 20:367-72. [DOI: 10.1016/j.jocn.2012.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 02/08/2012] [Indexed: 11/15/2022]
|
47
|
Sorkin GC, Hopkins LN. Endovascular correlates of cavernous sinus anatomy. World Neurosurg 2013; 82:e421-2. [PMID: 23376372 DOI: 10.1016/j.wneu.2013.01.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Grant C Sorkin
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - L Nelson Hopkins
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Toshiba Stroke and Vascular Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
| |
Collapse
|
48
|
Mergeani A, Popescu D, Laza C, Dorobat B, Bajenaru OA, Antochi F. A review on endovascular techniques for treatment of direct post-traumatic carotid-cavernous fistula supported by case presentations. MAEDICA 2012; 7:332-338. [PMID: 23483839 PMCID: PMC3593285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 09/26/2012] [Indexed: 06/01/2023]
Abstract
Direct carotid-cavernous fistula is an abnormal arteriovenous communication between the carotid artery and the cavernous sinus occurring spontaneously or following head trauma. The aim of this paper is to report our experience and a review of the literature regarding the curative effect of endovascular treatment for patients with post-traumatic direct CCF. We present five patients with direct post-traumatic CCF in whom endovascular treatment was applied and the outcomes of the endovascular treatment. Direct post-traumatic CCF may be completely occluded without technique-related complications using detachable balloons, coils as embolic material or by using covered stents placed in the parent vessel to exclude the fistula from circulation. Postembolization angiographies revealed that the fistula was successfully obliterated. Few days after the procedure the ophthalmic symptoms were much reduced, and completely resolved soon after.In conclusion endovascular treatment represents an effective method for complete occlusion the direct CCF no matter of the technique chosen.
Collapse
Affiliation(s)
- Athena Mergeani
- Clinic of Neurology, Emergency University Hospital, Bucharest, Romania
| | | | | | | | | | | |
Collapse
|
49
|
Lai XB, Li MH, Tan HQ, Luo BY, Zhu YQ, Wang J, Li YD. Predictors of in-stent stenosis and occlusion after endovascular treatment of intracranial vascular disease with the Willis covered stent. J Clin Neurosci 2012; 20:122-7. [PMID: 23137669 DOI: 10.1016/j.jocn.2012.01.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/21/2012] [Accepted: 01/23/2012] [Indexed: 11/28/2022]
Abstract
Covered stent placement has emerged as a promising therapeutic option for intracranial vascular lesions. However, in-stent stenosis and occlusion continue to be important concerns with the use of a covered stent, which is more thrombogenic than other types of stents. The purpose of this study was to determine predictors of in-stent stenosis and occlusion for covered stents used in the treatment of intracranial vascular diseases. Clinical, procedural and angiographic data of 46 patients with 49 intracranial vascular lesions treated with the Willis covered stent (Micro-Port, Shanghai, China) between April 2005 and October 2010 were collected and analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were performed to determine the factors predictive of in-stent stenosis and/or occlusion of the stents. In-stent stenosis and/or occlusion were documented at angiography in six patients with six lesions, and no stenoses or occlusions were seen at angiography in the remaining 40 patients with 43 lesions. Univariate analysis revealed that hypertension, post-procedure irregular antiplatelet therapy and cerebrovascular arteriosclerosis were associated with in-stent stenosis and/or occlusion. By multivariate logistic regression analysis, post-procedure irregular antiplatelet therapy (odds ratio [OR]=15; 95% confidence interval [CI], 1.172-192.004; p=0.037) and cerebrovascular arteriosclerosis (OR=19; 95% CI, 1.374-262.659; p=0.028) were independent predictors of in-stent stenosis and/or occlusion. Thus, post-procedure irregular antiplatelet therapy and coexistent cerebrovascular arteriosclerosis appear to increase the risk of in-stent stenosis and/or occlusion of covered stents in the treatment of intracranial vascular disease.
Collapse
Affiliation(s)
- Xiao-Biao Lai
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou 310003, China
| | | | | | | | | | | | | |
Collapse
|
50
|
Yu Y, Huang Q, Xu Y, Hong B, Zhao W, Deng B, Zhang Y, Liu J. Use of onyx for transarterial balloon-assisted embolization of traumatic carotid cavernous fistulas: a report of 23 cases. AJNR Am J Neuroradiol 2012; 33:1305-9. [PMID: 22492567 DOI: 10.3174/ajnr.a2977] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE TCCFs are a common complication following craniofacial trauma and are usually treated by coils or detachable balloons. The use of the liquid embolic agent Onyx as the sole agent for the treatment of TCCFs has been rarely reported. Herein, we summarized the preliminary experience and effectiveness of treating TCCFs with Onyx in 23 patients. MATERIALS AND METHODS From the 36 type A CCFs treated in our department between September 2005 and March 2011, a total of 23 posttraumatic direct CCFs were treated by using Onyx only via transarterial approach. RESULTS Immediate postprocedural angiograms demonstrated complete occlusion in all patients. All the patients underwent a single procedure except 1 with bilateral TCCFs. Up to 24-month clinical and 3-month angiographic follow-ups revealed an ongoing complete occlusion without any complications. CONCLUSIONS In this series, the use of Onyx for the transarterial embolization of TCCFs was feasible and effective. Associated adverse events were rare.
Collapse
Affiliation(s)
- Y Yu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | | | | | | | | | | | | |
Collapse
|