Multimodal Management of Carotid-Cavernous Fistulas

Sur, Samir; Menaker, Simon; Alvarez, Carlos M.; Chen, Stephanie; Shah, Sumedh S.; Peterson, Eric C.; Elhammady, Mohamed Samy; Starke, Robert M.

doi:10.1016/j.wneu.2019.10.004

Cited by 22 publications

(27 citation statements)

References 14 publications

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“…But some patients may have cerebral infarction or TCCF recurrence because of balloon premature detachment or deflation. In some complex TCCF, the fistula is too small or at an angle with ICA, so the balloon cannot enter, or the fistula is so large that the balloon cannot completely block the fistula [ 9 ]. Stent-graft embolization is the major therapy of TCCF today.…”

Section: Discussionmentioning

confidence: 99%

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

Zheng

2021

BioMed Research International

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The objective of this study was to observe the curative effect of combined arteriovenous approach embolization on complex carotid-cavernous fistulas. The clinical data of 13 patients with complex carotid-cavernous fistulas treated with combined arteriovenous approach embolization in our department between January 2017 and January 2020 were analyzed retrospectively. All 13 patients received the combined arteriovenous approach embolization with coil combined with Onyx glue. The intraoperative angiography immediately showed that the fistula could be completely blocked, and the carotid artery was/got unobstructed. The patients had no clinical symptoms recurring during a follow-up period of 3-18 months, on average 9.1 ± 6.3 months. A combined arteriovenous approach embolization on complex carotid-cavernous fistulas is safe and effective since it can improve the occlusion rate and reduce the relapse rate.

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Section: Discussionmentioning

confidence: 99%

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

Zheng

2021

BioMed Research International

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“…Type D fistulas (the most common type of low-flow fistulas) have communications between dural ICA and ECA branches and the CS. 6 7…”

Section: Discussionmentioning

confidence: 99%

“…5 Stents and flow diverters may also have a role in the cases with limited vessel tortuosity and large ICA tears. 5 6…”

Section: Discussionmentioning

confidence: 99%

Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical Note

Abaunza-Camacho

Vergara-García

Madriñán-Navia

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background Indirect carotid–cavernous fistulas (iCCFs) are shunts between meningeal branches of the internal carotid and/or the external carotid arteries and the cavernous sinus. They account for 83% of all carotid–cavernous fistulas (CCFs). Symptomatic iCCFs and those with increased risk of hemorrhage should be treated. Transvenous endovascular treatment is the preferred treatment modality. However, in complex cases, a combination of transarterial and transvenous approaches (multimodal treatment) is required. Methods A middle-aged woman presented with signs of increased intraocular pressure, blurry vision, diplopia, left proptosis, chemosis, conjunctival injection, ptosis, and cranial nerve VI palsy. Imaging confirmed the presence of a Barrow type D and Thomas type 4 iCCF with cortical venous reflux (CVR). Results The patient underwent transarterial and transvenous onyx embolization of the shunt, achieving a complete obliteration of the fistula. No complications occurred and the patient had a satisfactory postprocedural evolution. Conclusion Multimodal onyx embolization is an effective option for the treatment of a complex symptomatic iCCF. If CVR is identified, these lesions should be promptly treated to prevent hemorrhage secondary to rupture.

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“…(4,11) Las FCC se pueden clasificar según sus características hemodinámicas (alto o bajo flujo), por su etiología (traumática o espontánea), y por su anatomía, que es la que más comúnmente se usa y fue descrita por Barrow (1,4,5,9,11,12,13,14,15). La clasificación de Barrow divide las FCC en directas (tipo A) e indirectas (tipos B, C, D) según donde se encuentre la comunicación (4,9,13,16,17). Las fístulas Barrow A predominan en pacientes hombres, jóvenes y están asociadas en un 80-90% a trau-matismos craneoencefálicos (13).…”

Section: Discussionunclassified

Reporte de caso: fístula carótido-cavernosa post-traumática en un adolescente

Montero

González

Bonilla

2020

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Las FCCs son comunicaciones vasculares entre el sistema arterial carotídeo y el sistema de drenaje venoso cerebral; principalmente el seno cavernoso. A pesar de haber sido de las primeras lesiones vasculares intracerebrales en describirse, su poca ocurrencia dificulta la realización de grandes estudios que estandarice su abordaje y manejo. El objetivo de este caso clínico es describir una FCC diagnosticada en el Hospital México, de la Caja Costarricense de Seguro Social (CCSS) en San José Costa Rica, y de esta forma contribuir a la literatura médico-científica. Se reporta el caso de un paciente masculino de 17 años víctima de un politrauma, su sintomatología, el abordaje diagnóstico y la intervención terapéutica. A su vez se realiza una revisión del tema que evidencia la unicidad y variabilidad de esta patología, y se concluye que es indispensable la sospecha clínica y pronto manejo para así disminuir su morbilidad.

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Multimodal Management of Carotid-Cavernous Fistulas

Cited by 22 publications

References 14 publications

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical Note

Reporte de caso: fístula carótido-cavernosa post-traumática en un adolescente

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