scholarly journals Radiation Exposure During Diagnostic and Therapeutic Angiography of Carotid-cavernous Fistula

2021 ◽  
Author(s):  
Marcel Opitz ◽  
Georgios Alatzides ◽  
Sebastian Zensen ◽  
Denise Bos ◽  
Axel Wetter ◽  
...  
Keyword(s):  
Philips Healthcare ◽  
Carotid Cavernous Fistula ◽  
Flat Panel ◽  
Mean Values ◽  
Diagnostic Angiography ◽  
Retrospective Study Design ◽  
Carotid Cavernous Fistulas ◽  
Dose Levels ◽  
Neurointerventional Procedures ◽  
Dose Difference

Abstract Purpose The aim of this study was to determine local diagnostic reference levels (DRLs) during endovascular diagnostics and therapy of carotid-cavernous fistulas (CCF). Methods In a retrospective study design, DRLs, achievable dose (AD) and mean values were assessed for all patients with CCF undergoing diagnostic angiography (I) or embolization (II). All procedures were performed with the flat-panel angiography system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the type of CCF and the type of procedure. Results In total, 86 neurointerventional procedures of 48 patients with CCF were executed between February 2010 and July 2021. The following DRLs, AD and mean values could be determined: (I) DRL 215 Gy ∙ cm2, AD 169 Gy ∙ cm2, mean 165 Gy ∙ cm2; (II) DRL 350 Gy ∙ cm2, AD 226 Gy ∙ cm2, mean 266 Gy ∙ cm2. Dose levels of embolization were significantly higher compared to diagnostic angiography (p < 0.001). No significant dose difference was observed with respect to the type of fistula or the embolization method. Conclusion This article reports on diagnostic and therapeutic DRLs in the management of CCF that could serve as a benchmark for the national radiation protection authorities. Differentiation by fistula type or embolization method does not seem to be useful.

scholarly journals Radiation exposure in the endovascular therapy of cranial and spinal dural arteriovenous fistula in the last decade: a retrospective, single-center observational study

2021 ◽  
Author(s):  
Marcel Opitz ◽  
Sebastian Zensen ◽  
Denise Bos ◽  
Yan Li ◽  
Hanna Styczen ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Arteriovenous Fistula ◽  
Endovascular Therapy ◽  
Dural Arteriovenous Fistula ◽  
Complex Interventions ◽  
Spinal Dural Arteriovenous Fistula ◽  
Mean Values ◽  
Diagnostic Angiography ◽  
Retrospective Study Design ◽  
Dose Levels

Abstract Purpose This study aims to determine local diagnostic reference levels (DRLs) in the endovascular therapy (EVT) of patients with cranial and spinal dural arteriovenous fistula (dAVF). Methods In a retrospective study design, DRLs and achievable dose (AD) were assessed for all patients with cranial and spinal dAVF undergoing EVT (I) or diagnostic angiography (II). All procedures were performed at the flat-panel angiography-system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the region of fistula and the type of procedure. Results In total, 264 neurointerventional procedures of 131 patients with dAVF (94 cranial, 37 spinal) were executed between 02/2010 and 12/2020. The following DRLs, AD, and mean values could be determined: for cranial dAVF (I) DRL 507.33 Gy cm2, AD 369.79 Gy cm2, mean 396.51 Gy cm2; (II) DRL 256.65 Gy cm2, AD 214.19 Gy cm2, mean 211.80 Gy cm2; for spinal dAVF (I) DRL 482.72 Gy cm2, AD 275.98 Gy cm2, mean 347.12 Gy cm2; (II) DRL 396.39 Gy cm2, AD 210.57 Gy cm2, mean 299.55 Gy cm2. Dose levels of EVT were significantly higher compared to diagnostic angiographies (p < 0.001). No statistical difference in dose levels regarding the localization of dAVF was found. Conclusion Our results could be used for establishing DRLs in the EVT of cranial and spinal dAVF. Because radiation exposure to comparably complex interventions such as AVM embolization is similar, it may be useful to determine general DRLs for both entities together.

scholarly journals Direct carotid-cavernous fistulas occurring during neurointerventional procedures

2015 ◽  
Vol 22 (1) ◽  
pp. 91-96 ◽  
Author(s):  
Kenichiro Ono ◽  
Hidenori Oishi ◽  
Shunsuke Tanoue ◽  
Hiroshi Hasegawa ◽  
Kensaku Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Additional Treatment ◽  
Carotid Cavernous Fistula ◽  
Anterior Circulation ◽  
Cavernous Fistula ◽  
Carotid Cavernous Fistulas ◽  
Procedure Type ◽  
Neurointerventional Procedures

This study shows the frequency and types of carotid-cavernous fistula (CCF) complications that occurred during endovascular treatment. Transarterial endovascular surgeries involving the anterior circulation were performed for 1071 cases at our hospitals during four years. CCFs occurred in nine of 1071 cases (0.8%). CCF risk factors were female sex ( p = 0.032), aneurysmal location in the paraclinoid portion ( p < 0.001), and use of a distal access catheter (DAC) ( p < 0.001). There were no significant correlations between CCF risk and procedure type ( p = 0.411–1.0) and balloon use or nonuse ( p = 0.492). Eighty-nine percent (eight of nine) of the CCFs occurred at the genu of a cavernous internal carotid artery (ICA). Two cases of CCF disappeared spontaneously. The shunt was decreased by balloon expansion in one case, no additional treatment was required in one case, and five cases required transarterial fistula coil embolization. It is necessary to remember that a CCF may occur especially in aneurysmal treatment using a DAC in a female patient. The DAC and the 0.035-inch guidewire should be kept proximal to the carotid siphon and not go beyond it. When we cannot avoid navigating beyond it, we should consider using a softer DAC. In the case of a CCF caused by a DAC, it may be cured spontaneously or is treatable by transarterial coil embolization.

EFFECT OF OESTRONE-PELLET IMPLANTATION ON PLASMA LEVELS OF PROLACTIN

1970 ◽  
Vol 64 (2) ◽  
pp. 265-272 ◽  
Author(s):  
A. A. van der Gugten ◽  
M. Sala ◽  
H. G. Kwa
Keyword(s):  
Plasma Levels ◽  
Male Rats ◽  
Mean Values ◽  
The Mean ◽  
Dose Levels ◽  
Higher Doses ◽  
Primary Break

ABSTRACT Eight female and eight male rats were castrated at the age of 8 to 10 weeks. Four spayed and four orchidectomized rats received one oestrone/cholesterol pellet (200 μg oestrone) on the day of operation (day 0), a second pellet on day 11 and a third on day 23. The remaining animals received four oestrone/cholesterol pellets at these times. The fluctuations in the prolactin levels in the circulation induced by the oestrogen challenges in these animals were followed during 31 days by radioimmunoassays performed on days 3, 7, 9, 14, 15, 17, 23, 24, 25, 28 and 31. The results suggested that the homoeostatic mechanism regulating plasma levels of prolactin was capable of withstanding the three time-spaced oestrogen challenges only in the spayed animals receiving the lower doses of oestrogen, since it allowed the mean values of the prolactin levels to remain fairly constant during the first 4 weeks. The levels in this group rose to much higher levels only on day 31. The higher doses of oestrone in the spayed rats and both dose levels of oestrone in the orchidectomized animals apparently resulted in a primary break-down of the homoeostatic mechanism, since the prolactin levels in the animals of these groups rose to much higher levels either on day 7 or on day 9. This was followed by a period during which the prolactin levels appeared to be more or less under control, until a second and probably definitive failure of the homoeostatic mechanism allowed the mean levels to rise sharply again.

Experiences with surgical thrombosis of intracranial berry aneurysms and carotid cavernous fistulas

1974 ◽  
Vol 41 (6) ◽  
pp. 657-670 ◽  
Author(s):  
Sean Mullan
Keyword(s):  
Blood Flow ◽  
Intracranial Aneurysm ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Carotid Blood Flow ◽  
Giant Intracranial Aneurysm ◽  
Surgical Methods ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ The results of 61 cases of stereotaxic thrombosis of intracranial berry aneurysms indicate that the technique in selected cases is comparable to, but not necessarily superior to standard surgical methods. The results of wire-induced thrombosis in 15 cases of giant intracranial aneurysm suggest that this method is effective in situations where clipping and encapsulation are inapplicable. The results of thrombosis in six cases of carotid cavernous fistula suggest that intracavernous wire thrombosis may prove to be the treatment of choice in that it seals the fistula without impairing carotid blood flow.

Deflation of metrizamide-filled balloon used to occlude a carotid-cavernous fistula

1983 ◽  
Vol 59 (3) ◽  
pp. 524-528 ◽  
Author(s):  
Thomas J. Leipzig ◽  
Sean F. Mullan
Keyword(s):  
Contrast Agent ◽  
Vascular Wall ◽  
Carotid Cavernous Fistula ◽  
Technical Problems ◽  
Content Type ◽  
Cavernous Fistula ◽  
Short Summary ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ A carotid-cavernous fistula was occluded by a detachable latex balloon. Because of technical problems, the contrast-filled balloon was left in a precarious position in the ostium of the fistula. Premature deflation of the balloon would have resulted in intra-arterial migration of the device. Approximately 1 week is required for the balloon to become secured in place by fibrous attachment to the vascular wall. For success, if the ligature is adequate, a detachable Debrun balloon should remain inflated for this period of time. The deflation process was monitored radiographically in this patient. The balloon remained inflated for at least 2 weeks. A short summary of the experience with deflation of various contrast-containing balloon devices in the treatment of carotid-cavernous fistulas is given. Metrizamide may be the best contrast agent for use in these devices.

scholarly journals Pharmacokinetics and Safety of Intravenous Ceftolozane-Tazobactam in Healthy Adult Subjects following Single and Multiple Ascending Doses

2012 ◽  
Vol 56 (6) ◽  
pp. 3086-3091 ◽  
Author(s):  
Benjamin Miller ◽  
Ellie Hershberger ◽  
David Benziger ◽  
MyMy Trinh ◽  
Ian Friedland
Keyword(s):  
Single Dose ◽  
Adverse Events ◽  
Healthy Adult ◽  
Volume Of Distribution ◽  
Dose Administration ◽  
Mean Values ◽  
Multiple Doses ◽  
Dosing Regimens ◽  
Dose Levels ◽  
Dose Limiting Toxicity

ABSTRACTThe pharmacokinetics and safety of ceftolozane, a novel cephalosporin, and tazobactam, a β-lactamase inhibitor, alone and in combination as a 2:1 ratio in single doses of up to 2,000 and 1,000 mg of ceftolozane and tazobactam, respectively, and multiple doses of up to 3,000 and 1,500 mg of ceftolozane and tazobactam, respectively, per day were evaluated in healthy adult subjects. In part 1, groups of six subjects each received single ascending doses of ceftolozane, tazobactam, and ceftolozane-tazobactam in a within-cohort crossover design. In part 2, groups of 5 or 10 subjects each received multiple doses of ceftolozane, tazobactam, or ceftolozane-tazobactam for 10 days. After a single dose of ceftolozane alone, the ranges of mean values for half-life (2.48 to 2.64 h), the total clearance (4.35 to 6.01 liters/h), and the volume of distribution at steady state (11.0 to 14.1 liters) were consistent across dose levels and similar to those observed when ceftolozane was coadministered with tazobactam. Mean values after multiple doses for ceftolozane alone and ceftolozane-tazobactam were similar to those seen following a single dose. The pharmacokinetics of the dosing regimens evaluated were dose proportional and linear. Ceftolozane-tazobactam was well tolerated and systemic adverse events were uncommon. Mild infusion-related adverse events were the most commonly observed following multiple-dose administration. Adverse events were not dose related, and no dose-limiting toxicity was identified.

scholarly journals Endovascular treatment of carotid-cavernous fistula type A with platinium coils

2008 ◽  
Vol 65 (12) ◽  
pp. 923-926 ◽  
Author(s):  
Slobodan Culafic ◽  
Robert Juszkat ◽  
Sinisa Rusovic ◽  
Dara Stefanovic ◽  
Ljubodrag Minic ◽  
...  
Keyword(s):  
Type A ◽  
Endovascular Embolization ◽  
High Flow ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Vertebrobasilar Artery ◽  
Eye Symptoms ◽  
The Right ◽  
Carotid Cavernous Fistulas ◽  
Platinum Coils

Background. Carotid-cavernous fistulas are abnormal communications between carotid arteries or their branches and the cavernous system caused mostly by trauma. Posttraumatic fistulas represent 70% of all carotid-cavernous fistulas and they are mostly high-flow shunts (type A). This type gives characteristic eye symptoms. Case report. This paper presents a 44-year old male patient with carotidcavernous fistula as a result of penetrating head injury. In clinical presentation the patient had exophthalmos, conjunctival chemosis and weakening of vision on the right eye, headache and diplopia. Digital subtracted angiography showed high-flow carotid-cavernous fistula, which was vascularised from the left carotid artery and from vertebrobasilar artery. Endovascular embolization with platinum coils was performed through the transarterial route (endoarterial approach). Check angiogram confirmed that the fistula was closed and that no new communications developed. Conclusion. Embolization of complex carotidcavernous fistula type A was successfully performed with platinum coils by endovascular approach.

scholarly journals Venous Drainage Patterns in Carotid Cavernous Fistulas

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Ayse Aralasmak ◽  
Kamil Karaali ◽  
Can Cevikol ◽  
Utku Senol ◽  
Timur Sindel ◽  
...  
Keyword(s):  
Treatment Approach ◽  
Imaging Techniques ◽  
Venous Drainage ◽  
High Flow ◽  
Digital Subtraction ◽  
Carotid Cavernous Fistula ◽  
Drainage Patterns ◽  
Carotid Cavernous Fistulas ◽  
Mixed Types ◽  
Anterior Posterior

Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.

scholarly journals Comparison between different modalities of Endovascular treatment in Carotid Cavernous Fistula (CCF) and its short term outcome – Our Experience

2019 ◽  
Vol 8 (2) ◽  
pp. 68-76
Author(s):  
Mst Shamima Sultana ◽  
Md Shafiqul Islam ◽  
Md Sumon Rana ◽  
Kanij Fatema Ishrat Zahan Rifat ◽  
Md Abul Kalam Azad ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Carotid Cavernous Fistula ◽  
Short Term ◽  
Term Outcome ◽  
Invasive Approach ◽  
Cavernous Fistula ◽  
Short Term Outcome ◽  
Choice Of Treatment ◽  
Glue Embolization ◽  
Carotid Cavernous Fistulas

Introduction: Endovascular treatment offers different technique (Balloon assisted coiling / simple coiling, glue embolization) to treat Carotid Cavernous Fistula (CCF). This less invasive approach avoids morbidity and residual fistulas. The choice of treatment depends on the anatomy of the fistulas and cost effectiveness. Objective: To describe different endovascular treatment option of Carotid Cavernous fistulas (CCF), its short term outcome (clinical and angiographical) and to compare between trans-venous coiling and trans-arterial balloon assisted sinus coiling. Method: We have treated nine (9) cases of CCF during a period of three years. Out of them eight patients had direct CCF and one had indirect CCF. In two patients simple coiling done through trans-venous route and in another three patients through trans-arterial route. Balloon assisted coiling through trans-arterial route done in three patients. In two patients trans-arterial glue embolization was done. Results: Successful obliteration of fistula was achieved in all cases. Vision was improved in eight (8) patients. Postoperatively some proptosis remains in two patients. In one patient there was reappearance of proptosis two months after treatment, then balloon assisted coiling was done. One patient died from complication of glue (NBCA). Conclusion: Endovascular treatment is the mainstay of treatment in CCF. Trans-venous is the treatment of choice but recently balloon assisted sinus coiling through trans-arterial route is adopted. Bang. J Neurosurgery 2019; 8(2): 68-76

scholarly journals Hemicranial Cough-Induced Headache as a First Symptom of a Carotid-Cavernous Fistula-Case Report

Medicina ◽  
2020 ◽  
Vol 56 (4) ◽  
pp. 194
Author(s):  
Svetlana Simić ◽  
Ljiljana Radmilo ◽  
José R. Villar ◽  
Aleksandar Kopitović ◽  
Dragan Simić
Keyword(s):  
Aneurysm Rupture ◽  
Upper Respiratory Tract ◽  
Carotid Cavernous Fistula ◽  
Laboratory Findings ◽  
Cavernous Fistula ◽  
Upper Respiratory ◽  
Magnetic Resonance Imaging Mri ◽  
Angiographic Examination ◽  
The Right ◽  
Carotid Cavernous Fistulas

Background and objectives: Spontaneous carotid-cavernous fistulas (CCFs) are rare, and they may be caused by an aneurysm rupture. Materials and Methods: A case of a man hospitalized for high-intensity hemicranial headache with sudden cough onset as part of an upper respiratory tract infection is presented. The pain was of a pulsating character, localized on the right, behind the eye, followed by nausea and vomiting. Neurological finding registered a wider rima oculi to the right and slight neck rigidity. Laboratory findings detected a mild leukocytosis with neutrophil predominance, while cytobiochemical findings of CSF and a computerized tomography (CT) scan of the endocranium were normal. Results: Magnetic resonance imaging (MRI) angiography indicated the presence of a carotid cavernous fistula with a pseudoaneurysm to the right. Digital subtraction angiography (DSA) was performed to confirm the existence of the fistula. The planned artificial embolization was not performed because a complete occlusion of the fistula occurred during angiographic examination. Patient was discharged without subjective complaints and with normal neurological findings. Conclusions: Hemicranial cough-induced headache may be the first sign of carotid cavernous fistula, which was resolved by a spontaneous thrombosis in preparation for artificial embolization.

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