Carotid‐cavernous fistula in term pregnancy due to spontaneous rupture of carotid‐cavernous aneurysm

Doğan, Selen; Salman, Mehmet Çoşkun; Deren, Özgür; Geyik, Serdar

doi:10.1111/j.1447-0756.2011.01703.x

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…These results are consistent with the findings of a previous study: neointima formation is reduced by 60% in rats treated daily by oestrogens before and after balloon injury of carotid artery [ 84 ]. The role of oestrogens in spontaneous rupture of carotid-cavernous aneurysm has also been suspected during pregnancy in healthy females free from pregnancy-induced hypertension [ 85 , 86 ]. We could not find evidence of oestrogen taking in oral-contraceptives for example in our female vEDS patients who experienced direct sCCF, but it is noteworthy that the median age of pregnancy in these patients is quite similar to the median age of occurrence of their sCCF.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiology of carotid-cavernous fistulas in vascular Ehlers-Danlos syndrome: a retrospective cohort and comprehensive review

Adham

Trystram

Albuisson

et al. 2018

Orphanet J Rare Dis

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BackgroundVascular Ehlers-Danlos syndrome (vEDS) is a rare condition characterized by connective tissue fragility. Direct spontaneous carotid-cavernous fistula (sCCF) is reportedly pathognomonic of vEDS. We conducted this study to understand the possible mechanisms of occurrence of sCCF in this subset of patients.MethodsWe conducted a retrospective analysis of a monocentric vEDS cohort along with a literature review regarding sCCF in this condition.ResultsOf 133 patients regularly followed in our centre between 2000 and 2017, 13 (9.8%) had a diagnosis of direct sCCF (92.3% female, median age 33.0 years, interquartile range (IQR) [26.0–39.5]). There were 7 Glycine missense and 6 splice-site variants but no variant leading to haploinsufficiency. The literature search identified 97 vEDS patients with direct sCCF (79.4% female, 7.2% sex not reported, median age 31.0 years, IQR [24.0–39.0]). Increased carotid circumferential wall stress, higher carotid distensibility and lower carotid intima-media thickness could contribute to a higher risk for direct sCCF in vEDS. There is no predictive factor for the occurrence of sCCF apart from female sex in vEDS.ConclusionsIn vEDS, anatomical and pathophysiological features of the intra-cavernous internal carotid artery make it prone to shunting in the cavernous sinus, due either to a spontaneous rupture or to a spontaneous dissection with pseudoaneurysm formation. Direct sCCF in seemingly healthy young individuals should be highly suggestive of vEDS and prompt further investigation.

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Section: Discussionmentioning

confidence: 99%

Pathophysiology of carotid-cavernous fistulas in vascular Ehlers-Danlos syndrome: a retrospective cohort and comprehensive review

Adham

Trystram

Albuisson

et al. 2018

Orphanet J Rare Dis

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“…Aneurysm wrapping was used for one unruptured aneurysm Complications secondary to unruptured aneurysms were third nerve palsy (n = 1) and reduced visual acuity (n = 2). Two studies reported patients with reduced visual acuity, including one case that persisted after coil embolization for a suspected cavernous-carotid fistula (13,45).…”

Section: Aneurysm Treatmentmentioning

confidence: 99%

“…The decrease in blood pressure that occurs during the second trimester is followed by a rise back to or above the patient's normal blood pressure range throughout the third trimester and postpartum period (28, delivery in patients with ruptured (87% vs 13%) and unruptured (71% vs 29%) aneurysms. All twelve patients who gave birth before receiving treatment for aneurysm rupture underwent Cesarean deliveries (10,13,22,23,27,32,38,40,42). Six of these were part of a combined neurosurgical-obstetrical approach in which treatment (clipping, n = 3; coiling, n = 3) immediately followed delivery (10,23,27,32,38,42).…”

Section: Risk Of Rupture During Pregnancymentioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

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It has been estimated that 1.8% of women of childbearing age (16 to 44 years) develop intracranial aneurysms, however the incidence of unruptured intracranial aneurysms during pregnancy is not well established in the literature (25). Rupture of intracranial aneurysms occurs in the range of 1 to 10 per 100,000 pregnancies (1, 33). Case fatality from subarachnoid hemorrhage during pregnancy is reported as high as 83%, but outcomes have improved with better medical care (10, 12). Cerebrovascular management of aneurysms during pregnancy is complicated by the nature of maternal hemodynamics and their intimate relationship to the developing child. Given the dependence of the fetus on its mother, and the importance of a stable environment during fetal development, risk reduction from an intracranial aneurysm must clearly focus on both the mother and the child (39,40,42). Whether these aneurysms █ INTRODUCTIONAlthough intracranial aneurysms are uncommon during pregnancy, normal hemodynamic changes in pregnant women may increase vascular stress and the risk of aneurysm formation, progression and rupture (35,44,47). Systemically, maternal adaptations to pregnancy include increases in cardiac output (CO) and plasma volume (PV), and a redistribution of the CO between various organs (43). Cerebrovascular changes are thought to result from hormones that increase during pregnancy, such as estrogen, progesterone, and vascular endothelial growth factor (36). Other reported factors that may potentiate aneurysm progression during pregnancy include high levels of relaxin and increased wall tension from intraparenchymal artery hypoplasia (6, 51).Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms during pregnancy have not been clearly defined. The objective of this review is to describe the treatment options for pregnant women with intracranial aneurysms, and to report the maternal and fetal outcomes associated with different treatment strategies. A search of the literature was conducted using the PubMed database for the period January 1991 through June 2015. Aneurysm characteristics and management, pregnancy management, and maternal and fetal outcomes were evaluated. The most recent search was performed in June 2015. In total, 50 aneurysms (44 patients) were evaluated. Rupture was confirmed upon imaging in 36 aneurysms (72%), and most aneurysms ruptured during the third trimester (77.8%). Coil embolization was associated with a lower complication rate than clipping in patients with ruptured aneurysms (9.5% vs 23.1%). For patients with unruptured aneurysms, surgical management was associated with 31.9% fewer complications compared to no treatment. Most patients underwent Cesarean delivery (84%), and a combined neurosurgical-obstetrical procedure was used for 8 patients with ruptured aneurysms near term. Adverse outcomes were reported in 11.9% of children. Treatment of intracranial aneurysms during pregnancy is sa...

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“…More rarely, this lesion can be multiple and bilateral. 4,11,12 Despite classically being of traumatic etiology, the direct CCF can result from iatrogenic lesions, such as trans-sphenoidal or endovascular surgeries, 4,14,15,18,19 collagen deficiencies, as in the Ehlers-Danlos syndrome, ruptured intracavernous aneurysms, 4,12,13,20,21 dissections, osteogenesis imperfecta or even fibromuscular dysplasia. 4 …”

Section: Discussionmentioning

confidence: 99%

Advances in the endovascular treatment of direct carotid-cavernous fistulas

Aguiar

Jory

Silva

et al. 2016

Rev. Assoc. Med. Bras.

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Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.

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Carotid‐cavernous fistula in term pregnancy due to spontaneous rupture of carotid‐cavernous aneurysm

Cited by 5 publications

References 16 publications

Pathophysiology of carotid-cavernous fistulas in vascular Ehlers-Danlos syndrome: a retrospective cohort and comprehensive review

Pathophysiology of carotid-cavernous fistulas in vascular Ehlers-Danlos syndrome: a retrospective cohort and comprehensive review

The management of intracranial aneurysms during pregnancy: a systematic review

Advances in the endovascular treatment of direct carotid-cavernous fistulas

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