Treatment of direct carotid-cavernous fistulas with flow diversion – does it work?

Hüseyinoglu, Zeynep; Oppong, Marvin Darkwah; Griffin, Andrew; Hauck, Erik F.

doi:10.1177/1591019918808468

Cited by 9 publications

(9 citation statements)

References 25 publications

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“…Several case series have reported the safety and efficacy of flow diverter stents [1,[4][5][6][7][8][9][10][11]. However, most of the patients enrolled in these studies were adults or adolescents [1,4,11].…”

Section: Discussionmentioning

confidence: 99%

“…These effects can reduce the stenosis and thrombosis risk in the parent artery and prevent neurological complications [4]. Flow diverter stents may be used as a scaffold and treated with coils or liquid embolic substances [4,5]. In stand-alone treatments, multiple stents will usually be required to occlude the fistula completely [5].…”

Section: Discussionmentioning

confidence: 99%

“…Flow diverter stents may be used as a scaffold and treated with coils or liquid embolic substances [4,5]. In stand-alone treatments, multiple stents will usually be required to occlude the fistula completely [5].…”

Section: Discussionmentioning

confidence: 99%

“…Detachable coils, n-butyl-2-cyanoacrylate, and Onyx are normally used in the standard treatment. However, numerous studies have recently examined the use of flow diverter stents in CCF treatment [1,[4][5][6][7][8][9][10][11] although most of the patients were adults or adolescents. We herein reported a pediatric case of traumatic direct CCF successfully treated using a flow diverter stent with detachable coils.…”

Section: Introductionmentioning

confidence: 99%

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Flow diverter stents for pediatric traumatic carotid cavernous fistula: a case report and literature review

et al. 2021

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A 10-year-old, male patient with a head injury caused by a fall presented with chemosis, exophthalmos, right orbital bruit, and intracranial venous reflux, based on which posttraumatic carotid cavernous fistula (CCF) was diagnosed. Coil embolization was semi-urgently performed for the dangerous venous drainage. After the treatment, right abducens nerve palsy newly appeared. To treat the neurological symptoms and preserve the parent artery, curative endovascular treatment using a pipeline embolization device (PED) with coil embolization was performed after starting dual antiplatelet therapy (DAPT). The CCF and abducens nerve palsy finally resolved, and the internal carotid artery (ICA) was remodeled. Use of the PED with adjunctive coil embolization was effective and safe in the present case of pediatric traumatic direct CCF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Flow diverter stents for pediatric traumatic carotid cavernous fistula: a case report and literature review

et al. 2021

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“…In this case, the blood collects forming a pseudoaneurysmatic pouch, until it breaks generating a carotid-cavernous fistula (CCF), with a direct flow from the carotid artery (higher pressure area) to the cavernous sinus (lower pressure area). The high-speed flow makes CCF treatment by flow diversion challenging given the unfavorable hemodynamics, although some cases of CCF effectively treated with endovascular FDS positioning have been reported in the literature [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Emergency endovascular treatment of cavernous internal carotid artery acute bleeding with flow diverter stent: a single-center experience

Giorgianni¹,

Agosti

Terrana³

et al. 2020

Acta Neurochir

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Background and objective To describe our single-center experience in the treatment of cavernous internal carotid artery (ICA) acute bleeding with flow diverter stent (FDS), as a single endovascular procedure or combined with an endoscopic endonasal approach. Methods We analyze a case series of 5 patients with cavernous ICA acute bleeding, i.e., 3 iatrogenic, 1 post-traumatic, and 1 erosive neoplastic. After an immediate nasal packing to temporarily bleeding control, patients underwent digital subtraction angiography (DSA) to identify the site of the ICA injury. A concomitant balloon occlusion test (BOT) was performed, to exclude post-occlusive ischemic neurological damage. An FDS was placed with parallel intravenous infusion of abciximab in 3 cases and tirofiban in 2 cases. In two patients, an innovative "sandwich technique" combining the endovascular reconstruction with an extracranial intrasphenoidal cavernous ICA resurfacing with autologous flaps or grafts by endoscopic endonasal approach was performed. Results No patient had periprocedural ischemic-hemorrhagic complications. All patients had a regular clinical evolution, without general complications or new onset of focal neurological deficits. No further bleeding occurred in 3 patients, while 2 cases experienced a mild rebleeding in a period ranging from 5 to 15 days after the endovascular procedure. In these two cases, we proceeded with an endoscopic endonasal procedure to resurface the exposed ICA wall in the sphenoid sinus. Conclusions Although the treatment of choice for cavernous ICA acute bleeding remains the occlusion of the injured vessel, in cases of poor hemodynamic compensation at the BTO, the endovascular FDS emergency placement can be effective. A combined endoscopic endonasal technique to support the extracranial side of the vessel using autologous flaps or grafts can be performed to prevent the risk of rebleeding.

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A Direct Carotid Cavernous Sinus Fistula Treated with Transarterial Coil Occlusion of the Cavernous Aneurysm with Preservation of the Parent Artery

Mikeladze

Yakovlev²

2023

The Arteriovenous Malformations and Fistulas Casebook

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Treatment of direct carotid-cavernous fistulas with flow diversion – does it work?

Cited by 9 publications

References 25 publications

Flow diverter stents for pediatric traumatic carotid cavernous fistula: a case report and literature review

Flow diverter stents for pediatric traumatic carotid cavernous fistula: a case report and literature review

Emergency endovascular treatment of cavernous internal carotid artery acute bleeding with flow diverter stent: a single-center experience

A Direct Carotid Cavernous Sinus Fistula Treated with Transarterial Coil Occlusion of the Cavernous Aneurysm with Preservation of the Parent Artery

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