Endovascular treatment of pseudo-aneurysm occurring after embolization of traumatic carotid cavernous fistula with detachable balloons

Endovascular treatment of high-flow direct traumatic carotid cavernous fistula (CCF) carries many difficulties. One of them is that carotid dissection may be associated with pseudo-aneurysm formation even when the CCF can be successfully embolized by detachable balloons. This article details a unique technique of treating pseudo-aneurysm by obstructing the lumen with preservation of the parent artery. The case presented here involves a 50-year-old man with a history of severe trauma. The angiography revealed that his bilateral high-flow carotid cavernous fistula was successfully embolized by detachable balloons and control digital subtraction angiography at the end of the procedure demonstrated the fistula closed and the internal carotid artery preserved. But two months later, a pseudo-aneurysm formed in the right internal carotid artery. Under endovascular treatment along with other techniques including coils, stent-assisted and covered stent, the pseudo-aneurysm was excluded with preserved ICA. Two years later, the fistula and pseudo-aneurysm both disappeared quietly without patent foreign body reaction in the parent arterial wall.

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Evaluation of cerebral oximetry during endovascular treatment of carotid-cavernous fistula

10.1117/12.280280 ◽

1997 ◽

Author(s):

Manuel Dujovny ◽

Mukesh Misra ◽

M. Serdar Alp ◽

Gerard Debrun ◽

F. T. Charbel ◽

...

Keyword(s):

Endovascular Treatment ◽

Cerebral Oximetry ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula

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

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v8i2.42347 ◽

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

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Pericardium Covered Stent Graft for Endovascular Treatment of a Traumatic Carotid-cavernous Fistula

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.196438 ◽

2016 ◽

Vol 07 (S 01) ◽

pp. S137-S138

Author(s):

Dale Ding ◽

Robert M. Starke ◽

Maurice Moriarty ◽

Stefan Brew

Keyword(s):

Endovascular Treatment ◽

Stent Graft ◽

Covered Stent ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Covered Stent Graft

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Endovascular Treatment in an Unusual Case of Direct Carotid Cavernous Fistula

The Neuroradiology Journal ◽

10.15274/nrj-2014-10032 ◽

2014 ◽

Vol 27 (2) ◽

pp. 207-212 ◽

Cited By ~ 2

Author(s):

Rajendra Gajanan Chavan ◽

Ravindra Bhimrao Kamble ◽

Vivek Bonde

Keyword(s):

Endovascular Treatment ◽

Unusual Case ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Direct Carotid Cavernous Fistula

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Use of Solitaire™ retrievable stent-assisted coiling technique for endovascular treatment of post-traumatic direct carotid cavernous fistula

Diagnostic and Interventional Imaging ◽

10.1016/j.diii.2016.03.002 ◽

2016 ◽

Vol 97 (11) ◽

pp. 1193-1195

Author(s):

O. Fatih Nas ◽

R. Buyukkaya ◽

E. Kacar ◽

C. Erdogan ◽

B. Hakyemez

Keyword(s):

Endovascular Treatment ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Post Traumatic ◽

Direct Carotid Cavernous Fistula ◽

Retrievable Stent

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Carotid-cavernous fistula caused by laceration of persistent fetal trigeminal artery treated with single catheter coil embolization

Indian Journal of Neurosurgery ◽

10.4103/2277-9167.94375 ◽

2012 ◽

Vol 01 (01) ◽

pp. 072-074

Author(s):

Anthony Sin ◽

Hugo Cuellar ◽

Benjamin Brown

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Coil Embolization ◽

Internal Carotid ◽

Trigeminal Artery ◽

Carotid Cavernous Fistula ◽

Unique Challenge ◽

Cavernous Fistula ◽

Catheter Technique ◽

Safe Treatment Option

Abstract We present the endovascular treatment of traumatic carotid-cavernous fistula from persistent fetal trigeminal artery (PFTA) laceration. To date, there are six such cases of traumatic PFTA-cavernous fistulas reported in the literature. These injuries can pose a unique challenge in that rupture of a PFTA in its course through the cavernous sinus may produce a fistula feeding from both anterior and posterior circulations. Previously, these have been treated with dual catheter coil embolization from the carotid and basilar systems. We utilize a single catheter technique accessing the cavernous sinus through the origin of the PFTA on the internal carotid. Both anterior and posterior fistula components may be embolized through this single access. This represents a simple yet safe treatment option.

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Traumatic Cerebral Aneurysm Associated with a Contralateral Traumatic Carotid Cavernous Fistula

Interventional Neuroradiology ◽

10.1177/159101990701300309 ◽

2007 ◽

Vol 13 (3) ◽

pp. 287-293 ◽

Cited By ~ 1

Author(s):

A. Fuse ◽

H. Yokota ◽

S. Kominami ◽

Y. Yamamoto

Keyword(s):

Head Injury ◽

Endovascular Treatment ◽

Clinical Symptoms ◽

Closed Head Injury ◽

Cross Flow ◽

Anterior Communicating Artery ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Traumatic Subarachnoid Hemorrhage ◽

Contralateral Internal Carotid Artery

This report documents the management of a traumatic carotid aneurysm (TCA) with a traumatic carotid-cavernous fistula (T-CCF) of the contralateral internal carotid artery (ICA) following a closed head injury. A 38-year-old man presented with severe traumatic subarachnoid hemorrhage and pneumocephalus due to a severe head injury. Four months after the accident, the patient presented with clinical symptoms of exophthalmos and retroorbital bruit. Cerebral angiography showed a TCA of the IC-PC region, which coexisted with a contralateral T-CCF. Both lesions were successfully managed with an endovascular treatment using coils to isolate a fistula from the ICA, and direct surgical trapping of the intracranial ICA to eliminate a TCA. Post-operative angiography revealed a good cross-flow through the anterior communicating artery from the contralateral ICA, which was completely obliterated by the T-CCF. No additional surgical or endovascular procedure for traumatic vascular injuries was required. The patient remained asymptomatic during the clinical follow-up period of 24 months. The goal of traumatic carotid injuries is the selective elimination of the vascular pathologic injury with asymptomatic state, using direct surgery and/or an endovascular treatment.

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