Angioarchitecture and Treatment Modalities in Posttraumatic Carotid Cavernous Fistulae

Abstract

<jats:p> Posttraumatic carotid cavernous fistulae are abnormal direct hole communications between the intracavernous carotid artery and the cavernous sinus that can result from both blunt and penetrating trauma. They can be challenging lesions to treat and a variety of modalities and approaches have been proposed since endovascular treatment has become the standard treatment. </jats:p><jats:p> An analysis of the angioarchitecture of 32 consecutive patients treated in our service demonstrated that seven could be classified as small hole, eight medium and 17 large. Different size fistulae required varying endovascular tools. Small fistulae were best treated using coils and large and medium lesions with balloons. Large lesions were more likely to require multiple tools in order to achieve closure and had a lower chance of ipsilateral carotid preservation. All patients in the series were cured with a carotid preservation rate of 66%. There was no permanent morbidity associated with endovascular treatment. </jats:p>

Transvenous Target Embolization for a Small Sized, Non-traumatic Direct Carotid-cavernous Fistula using a Single Coil: Technical Case Report

“…7) However, in the literature, many studies reported the results of transarterial embolization. 3,[8][9][10] According to a study, 9) transarterial coil embolization was performed for 12 patients with small, direct CCF, and the mean number of coils was 8.4 (2-16). Another study presented five patients who underwent transarterial embolization with a balloon for the ICA, with a mean coil count of 11.2 (6-18).…”

“…2) Another study classified the fistulous size into three categories: i) small when a sufficient volume of blood flow at the periphery is confirmed on angiography of the internal carotid artery; ii) medium when there is no fistulous visualization through the contralateral ICA despite a decrease in peripheral blood flow or its disappearance, and iii) large when a fistula is visualized through the contralateral ICA or P-com in the absence of peripheral blood flow, and indicated that small fistulas accounted for 21.9%. 3) These classifications have a limitation: individual differences in A-com and P-com developments are not considered. However, they are useful for simply predicting the fistulous size.…”

Endovascular treatment of carotico-cavernous fistulas with acrylic glue: a series of nine cases

“…Flow diverters and covered stents have gained interest as devices suitable to treat CCFs [16, 17]. However, besides being expensive, they require antiplatelet treatment for at least 3–6 months, sometimes life-long, with subsequent risk of adverse events before the device is endothelialized.…”

“…Using glue to close CCF represents a crucial moment when the fistula closes, as the flow could be directed into the still patent ICA with risk of distal glue embolization with possible detrimental consequences [17]. It is the reason why we have chosen to inject the glue under angiographic runs at 3 frames/s so that precise visualization of the glue can be obtained.…”

Brainstem Hemorrhage Caused by Direct Carotid-Cavernous Fistula

“…Occasionally, a large lesion has less chance of ipsilateral carotid preservation; arterial sacrifice with parent artery occlusion is needed in life-threatening cases. Malan et al 22 classified post-traumatic CCF into small, medium and large fistulae based on angioarchitecture, which is helpful in selecting varying endovascular tools. We found the venous pouch disruption in our patient was large and contained extensive thrombus.…”