Treatment of Carotid Cavernous Fistulas Using Covered Stents: Midterm Results in Seven Patients

Gomez, F.; Escobar, William; Gomez, Abel; Gomez, Javier; Anaya, C.A.

doi:10.3174/ajnr.a0636

Cited by 107 publications

(89 citation statements)

References 29 publications

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“…Although they are excellent therapeutic devices, there are some situations when detachable balloons cannot be used, if preservation of the parent artery is desired, particularly when the following are present : 1) a small orifice that does not allow the balloon passage, 2) a small cavernous sinus that causes the balloon to be herniated into the parent ICA, 3) sharp osseous fragments within the sinus that can cause rupture balloon on inflation, 4) a markedly enlarged cavernous sinus that cannot be completely filled by even multiple balloons, which leaves empty spaces that prevent complete occlusion and cure, and 5) transection of the cavernous ICA. In addition, the use of detachable balloons may also be limited by their availability 8) .…”

Section: Discussionmentioning

confidence: 99%

“…Gomez et al 8) reported treating seven post-traumatic CCF patients with a graft-stent. One-month follow-up angiograms demonstrated occlusion of stented ICAs and the preservation of intracranial circulation via collateral flow in one patient who interrupted prescribed antiplatelet medication soon after discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Gomez et al 8) used an additional graft-stent or detachable coils to treat residual fistula filling, and Archondakis et al 1) reported that postdilation using a coronary balloon of larger diameter is often needed to exclude an endoleak completely after graft-stent placement for traumatic CCF. In our cases, graft-stents were repeatedly dilated at high balloon inflation pressures to resolve this problem.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Graft-Stent Placement for Treatment of Traumatic Carotid Cavernous Fistulas

Choi

Lee

Kim

et al. 2009

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 46 : [572][573][574][575][576] 2009 Detachable balloon-based endovascular fistula occlusion is a widely accepted treatment for traumatic carotid cavernous fistulas (CCF). However, more recently coils have been used to obliterate the lesion, especially in case detachable balloon is not available. We failed balloon-assisted coil embolization for CCF because of large fistulas and herniation of coil loops into the parent artery. The authors describe our experiences of balloonexpandable graft-stents to treat CCF, and place emphasis on arterial wall reconstruction. Three traumatic CCF patients were treated using a graft-stent with/without coils, and underwent angiographic follow-up to evaluate the patency of the internal carotid artery (ICA). In all cases, symptoms related to CCF regressed after stent deployment and did not recur during follow-up. Follow-up angiography revealed good patency of the ICA in all patients. Graft-stents should be considered as an alternative means of treating CCF and preserving the parent artery by arterial wall reconstruction especially in patients with a fistula that cannot be successfully occluded with detachable balloons or coils.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endovascular Graft-Stent Placement for Treatment of Traumatic Carotid Cavernous Fistulas

Choi

Lee

Kim

et al. 2009

J Korean Neurosurg Soc

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“…Jostent has been used for aneurysms up to the ophthalmic artery or up to the vertebrobasilar junction [9,10]. The Graftmaster has also been used for carotidocavernous fistulas and dissections [11]. Bergeron et al recently published a series of six patients with EICA in which stent-grafts were used.…”

Section: Covered Stentsmentioning

confidence: 99%

Endovascular Treatment of Internal Carotid and Vertebral Artery Aneurysms Using Covered Stents

Vulev¹,

Klepanec²

2012

Aneurysm

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“…After stent deployment, there was persistent narrowing at the end of the stent due to an intimal flap, which may have been the cause of the occlusion. Two reports of asymptomatic complete ICA occlusion have been described following carotid cavernous fistula repair 10 hyperplasia within the stent 10 ". McNeil et al 2 and Parodi et al 4 described 50% and 90% restenosis of the ICA in two patients following management of traumatic pseudoaneurysms with stent grafts.…”

Section: Casementioning

confidence: 99%

In-Stent Stenosis Following Covered Stent-Graft Placement

Flood

Bussiére

Teefy

et al. 2009

Can. j. neurol. sci.

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Internal carotid artery (ICA) covered stent-grafts are increasingly utilized for the endovascular management of traumatic carotid pseudoaneurysms 1 " 9 , carotid-cavernous fistulas 1012 , large petrous/cavernous carotid aneurysms 12 and carotid blow-out syndrome 7 . Early covered stent grafts were selffabricated using polytetrafluoroethylene or autologous vein mounted onto bare metal stents. Pre-mounted balloon expandable or self-expanding stent-grafts are now commercially available. Covered stents provide an alternate treatment option for high surgical risk or inaccessible lesions or when observation and anticoagulation are less than desirable. Potential advantages of covered stent grafts include minimal invasiveness, shorter hospital stays, lower cost and less post-procedural pain. Caution in the application of this relatively new technology and careful follow-up are required, however, as is illustrated by two patients with internal carotid artery stenosis following covered stent-graft placement. Case IA 24-year-old previously healthy right-handed woman was the belted driver in a vehicle roll-over. She sustained multiple injuries including fractures of the odontoid process of C2 and the left transverse process of C7. A computed tomogram (CT) head performed at the time of admission was unremarkable. The patient was sedated, intubated and treated with hypothermia according to the institutional protocol. As the sedation dissipated 24-hours later, the patient was found to be aphasic with mild right-sided face and arm weakness. A repeat CT head demonstrated a subacute left fronto-temporal infarct and CT angiography revealed left internal carotid artery (ICA) occlusion, presumed to be secondary to arterial dissection. Antiplatelet therapy was initiated at this time.The patient made a good functional recovery with significant improvement in speech and complete recovery of motor function. A one-month follow-up CT angiogram demonstrated recanalization of the left ICA but development of a pseudoaneurysm at the level of the first cervical vertebrae. Serial noninvasive angiography over three months demonstrated progressive enlargement of the pseudoaneurysm and consequently the patient was referred for endovascular management to prevent its continued expansion and decrease the future risk of a recurrent ischemic event.Given the angio-architecture of the pseudoaneurysm, covered stent graft placement or vessel occlusion were considered as the safest and effective treatment options. An approach preserving

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Treatment of Carotid Cavernous Fistulas Using Covered Stents: Midterm Results in Seven Patients

Cited by 107 publications

References 29 publications

Endovascular Graft-Stent Placement for Treatment of Traumatic Carotid Cavernous Fistulas

Endovascular Graft-Stent Placement for Treatment of Traumatic Carotid Cavernous Fistulas

Endovascular Treatment of Internal Carotid and Vertebral Artery Aneurysms Using Covered Stents

In-Stent Stenosis Following Covered Stent-Graft Placement

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