Delayed caroticocavernous fistula after stent-assisted coil embolization of intracavernous carotid aneurysm: should we manage conservatively?

Chan, Huan Wee; Haliasos, Nikolaos; Derakhshani, Shahram; Vindlacheruvu, Raghu; Chawda, Sanjiv

doi:10.1007/s00701-011-0968-7

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…While no patient treated with PED in PUFS experienced aneurysm rupture that resulted in subarachnoid hemorrhage to date, one patient developed a subacute carotid cavernous fistula after PED treatment of a cavernous segment aneurysm-an untoward outcome also infrequently known to complicate stent-assisted coil treatment of cavernous segment aneurysms (35). Rupture of previously unruptured intradural aneurysms has also been described (31,36,37) after treatment with parent vessel occlusion and coil placement, however, as with endoluminal devices such as PED, the causative mechanism of this adverse occurrence remains obscure.…”

Section: Discussionmentioning

confidence: 99%

Pipeline for Uncoilable or Failed Aneurysms: Results from a Multicenter Clinical Trial

et al. 2013

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Purpose:To evaluate the safety and effectiveness of the Pipeline Embolization Device (PED; ev3/Covidien, Irvine, Calif) in the treatment of complex intracranial aneurysms. Materials and Methods:The Pipeline for Uncoilable or Failed Aneurysms is a multicenter, prospective, interventional, single-arm trial of PED for the treatment of uncoilable or failed aneurysms of the internal carotid artery. Institutional review board approval of the HIPAA-compliant study protocol was obtained from each center. After providing informed consent, 108 patients with recently unruptured large and giant wide-necked aneurysms were enrolled in the study. The primary effectiveness endpoint was angiographic evaluation that demonstrated complete aneurysm occlusion and absence of major stenosis at 180 days. The primary safety endpoint was occurrence of major ipsilateral stroke or neurologic death at 180 days. Results:PED placement was technically successful in 107 of 108 patients (99.1%). Mean aneurysm size was 18.2 mm; 22 aneurysms (20.4%) were giant (.25 mm). Of the 106 aneurysms, 78 met the study's primary effectiveness endpoint (73.6%; 95% posterior probability interval: 64.4%-81.0%). Six of the 107 patients in the safety cohort experienced a major ipsilateral stroke or neurologic death (5.6%; 95% posterior probability interval: 2.6%-11.7%). Conclusion:PED offers a reasonably safe and effective treatment of large or giant intracranial internal carotid artery aneurysms, demonstrated by high rates of complete aneurysm occlusion and low rates of adverse neurologic events; even in aneurysms failing previous alternative treatments.q RSNA, 2013

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Section: Discussionmentioning

confidence: 99%

Pipeline for Uncoilable or Failed Aneurysms: Results from a Multicenter Clinical Trial

et al. 2013

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“…Another rare complication after flow diversion for the treatment of carotid cavernous aneurysms is the delayed rupture of a cavernous carotid aneurysm leading to the development of a carotid-cavernous fistula. This was noted in PUFS and has been noted with stent assisted coiling in the past [63].…”

Section: Delayed Aneurysmal Rupturementioning

confidence: 54%

Flow Diversion for Intracranial Aneurysm Management: A New Standard of Care

et al. 2016

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Endovascular treatment of intracranial aneurysms with complex morphologies such as giant, wide-necked, or fusiform aneurysms is challenging. Stent-assisted coiling and balloon-assisted coiling are alternative techniques to treat such complex aneurysms, but studies have shown less-than-expected efficacy, as suggested by their high rate of recanalization. The management of complex aneurysms via microsurgery or conventional neuroendovascular strategies has traditionally been poor. However, over the last few years, flow-diverting stents (FDS) have revolutionized the treatment of such aneurysms. FDS are implanted within the parent artery rather than the aneurysm sac. By modifying intra-aneurysmal and parent-vessel flow dynamics at the aneurysm/parent vessel interface, FDS trigger a cascade of gradual intra-aneurysmal thrombosis. As endothelialization of the FDS is complete, the parent vessel reconstructs while preserving the patency of normal perforators and side branch vessels. As with any intervention, the practice and application of flow-diversion technology is inherent, with risks that include vessel rupture or perforation, in-stent thrombosis, perforator occlusion, procedural and delayed hemorrhages, and perianeurysmal edema. Herein, we review the devices, their mechanisms of actions, clinical applications, complications, and ongoing studies.

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“…Chan et al 21 reported on a CCA that was treated with a Neuroform stent and Axium coils. The patient presented at 1 month postoperatively with proptosis, chemosis, and ophthalmoplegia and angiography revealed a CCF.…”

Section: Discussionmentioning

confidence: 99%

Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature

Roy

Grossberg

Osbun

et al. 2016

J NeuroIntervent Surg

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CCF formation is a known risk of PED treatment of CCA. Although transvenous embolization can be used for treating CCFs, parent artery sacrifice remains a viable option on the basis of these data. Studies support the view that adjunctive coiling may have a protective effect against post-PED CCF formation. None of the coiled aneurysms in our database or in the literature have ruptured. Follow-up data will lead to a better understanding of the safety profile of the PED for CCA.

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Delayed caroticocavernous fistula after stent-assisted coil embolization of intracavernous carotid aneurysm: should we manage conservatively?

Cited by 9 publications

References 17 publications

Pipeline for Uncoilable or Failed Aneurysms: Results from a Multicenter Clinical Trial

Pipeline for Uncoilable or Failed Aneurysms: Results from a Multicenter Clinical Trial

Flow Diversion for Intracranial Aneurysm Management: A New Standard of Care

Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature

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