Transvenous Embolization of a Carotid Cavernous Fistula Complicated by a Hematoma at the Tentorial Edge

Baharvahdat, Humain; Shabestari, Mahmood; Zabihyan, Samira; Etemadresaei, Hamid; Blanc, Raphaël; Piotin, Michel

doi:10.15274/inr-2014-10036

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…Procedure-related ICH, such as SDH or IVH, could be caused by the rupture of venous access during IPS recanalization, the rupture of the venous pouch during microcatheterization or packing, or the occlusion of draining veins such as the SPS. 5,26,27 Diabetes insipidus is another rare complication of indirect CCF embolization with LEAs; 28 as we showed, it usually appears in the first week of EVT and is resolved within 3 months.…”

Section: Discussionsupporting

confidence: 50%

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

Baharvahdat,

Qoorchi Moheb Seraj,

Al-Raaisi

et al. 2024

Neurosurgical Focus

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OBJECTIVE Endovascular treatment (EVT) is the primary approach used to treat indirect carotid-cavernous fistulas (CCFs). In this study, the authors evaluated the immediate and long-term efficacy and safety of different endovascular techniques for indirect CCFs. METHODS The databases of two endovascular centers were retrospectively reviewed to collect the patients with indirect CCFs treated using endovascular techniques between 2013 and 2023. Demographics, clinical presentation, CCF features, EVT characteristics, and clinical and radiological outcomes were evaluated and analyzed. The analysis was performed to compare the clinical and radiological data between different endovascular approaches and different embolic materials. RESULTS Ninety-eight patients were included in the study. EVT was successful in 95 patients (96.9%). Immediate complete obliteration of the CCF was achieved in 93.9% of patients, with 98% undergoing embolization with liquid embolic agents (LEAs) and 95.6% undergoing coiling alone. Complete CCF obliteration was higher in the transvenous than in the transarterial approach (94.3% vs 75%, p = 0.010). At ≥ 6 months follow-up, complete CCF obliteration was achieved in all patients (100%). The rate of procedure-related complications was higher following LEAs than with coiling alone (32.0% vs 15.6%). New cranial nerve (CN) palsy was diagnosed in 26.0% and 2.2% after embolization with LEAs and coiling alone, respectively (p = 0.001), with complete CN palsy recovery in 78.6%. Procedure-related intracranial hemorrhage occurred in 3 patients (3.1%). Two patients experienced an ischemic stroke following Onyx migration into the internal carotid artery. Ocular symptoms improved in 93% (83/89) of the patients who were followed. CONCLUSIONS In this study, complete obliteration of an indirect CCF was achieved in more than 90% of patients. Despite the occurrence of some new postprocedural ocular CN palsy, ocular symptoms improved in most patients in long-term follow-up. The transvenous approach was the most effective method for treating the indirect CCF. Coiling was safer than LEAs for the embolization of the indirect CCF.

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Section: Discussionsupporting

confidence: 50%

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

Baharvahdat,

Qoorchi Moheb Seraj,

Al-Raaisi

et al. 2024

Neurosurgical Focus

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“…The chances of successful recanalization of the IPS are more when duration of illness is less. In chronic cases where the occlusion is organized and fibrosis has taken place, it is not possible and also not advised to attempt for IPS recanalization due to increased risk of complications in the form of SDH [9,21]. In one other case where we could not recanalize IPS, we approached the cavernous sinus through USG-guided direct puncture of the facial vein.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, sometimes, a long compliant balloon needs to be kept in cavernous ICA to prevent reflux of liquid embolic agent into the ICA through tiny dural feeders. All these techniques need proper training and expertise to master and have been described in literature for embolization of dural fistula [4,9,10,16,21].…”

Section: Discussionmentioning

confidence: 99%

Dural carotid-cavernous fistulas: our experience with endovascular management

Prasad

Singh

Kanaujia

et al. 2021

Egypt J Radiol Nucl Med

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Background Indirect carotid-cavernous fistulas (CCF) are dural arteriovenous fistula of the cavernous sinus and generally present with ocular symptoms. High index of clinical suspicion and radiological work up is required for diagnosis, and treatment is primarily endovascular embolization. We present our experience in diagnosis and management of indirect CCF along with technical evolution to perform embolization and different vascular accesses for difficult anatomy. Results Among a total of 20 indirect CCF cases who were treated with embolization in our department from 2013 to 2020, five (25%) were type C and 15 (75%) were type D. Seven were treated with trans-arterial access only, 11 were treated by transvenous access only, and two were treated by taking both transvenous and trans-arterial access. No recurrence was seen in angiographically cured patients. Out of seven patients who suffered various grades of visual deficit, five recovered completely and two had fixed visual deficit. Third and sixth cranial nerve palsy persisted in two patients even after CCF embolization. Conclusion Indirect CCF is a treatable cause of troublesome ocular symptoms. Endovascular embolization is preferred treatment with excellent short- and long-term outcome. The embolization becomes difficult and challenging in cases where the conventional vascular access to the cavernous sinus is occluded.

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“…The purpose of venous embolization is to occlude the fistula without rerouting venous drainage to conical structures. When catheterization is possible, transvenous embolisation has high (100%) occlusion rates [15] .…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Carotid Cavernous Fistulae: A Study of Management and Outcome

Mudalgi¹

2017

JMSCR

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Transvenous Embolization of a Carotid Cavernous Fistula Complicated by a Hematoma at the Tentorial Edge

Cited by 3 publications

References 17 publications

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

Dural carotid-cavernous fistulas: our experience with endovascular management

Endovascular Treatment of Carotid Cavernous Fistulae: A Study of Management and Outcome

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