scholarly journals Endovascular Treatment of Traumatic Carotid Cavernous Fistula with Balloon-Assisted Sinus Coiling

2013 ◽  
Vol 19 (4) ◽  
pp. 445-454 ◽  
Author(s):  
Gustavo Andrade ◽  
Moysés L. Ponte De Souza ◽  
Romero Marques ◽  
José Laércio Silva ◽  
Carlos Abath ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Femoral Artery ◽  
Venous Drainage ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Cavernous Fistula ◽  
Percutaneous Access ◽  
Endovascular Approach ◽  
The Right

This study aimed to propose an alternative treatment for carotid cavernous fistula (CCF) using the balloon-assisted sinus coiling (BASC) technique and to describe this procedure in detail. Under general anesthesia, we performed the BASC procedure to treat five patients with traumatic CCF. Percutaneous access was obtained via the right femoral artery, and a 7F sheath was inserted, or alternatively, a bifemoral 6F approach was accomplished. A microcatheter was inserted into the cavernous sinus over a 0.014-inch microwire through the fistulous point; the microcatheter was placed distal from the fistula point, and a “U-turn” maneuver was performed. Through the same carotid access, a compliant balloon was advanced to cross the point of the fistula and cover the whole carotid tear. Large coils were inserted using the microcatheter in the cavernous sinus. Coils filled the adjacent cavernous sinus, respecting the balloon. Immediate complete angiographic resolution was achieved, and an early angiographic control (mean = 2.6 months) indicated complete stability without recanalization. The clinical follow-up has been uneventful without any recurrence (mean = 15.2 months). An endovascular approach is optimal for direct CCF. Because the detachable balloon has been withdrawn from the market, covered stenting requires antiplatelet therapy and its patency is unconfirmed, but cavernous sinus coiling remains an excellent treatment option. Currently, there is no detailed description of the BASC procedure. We provide detailed angiograms with suitable descriptions of the exact fistula point, and venous drainage pathways. Familiarity with these devices makes this technique effective, easy and safe.

Treatment of a carotid cavernous fistula via direct transovale cavernous sinus puncture

2013 ◽  
Vol 119 (1) ◽  
pp. 247-251 ◽  
Author(s):  
Alberto Gil ◽  
Luis López-Ibor ◽  
Gerardo Lopez-Flores ◽  
Hugo Cuellar ◽  
Eduardo Murias ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Foramen Ovale ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Complete Obliteration ◽  
Feasible Alternative ◽  
Carotid Cavernous Fistulas

Endovascular treatment is the treatment of choice for indirect carotid cavernous fistulas (CCFs). Direct surgical obliteration of CCFs is recommended in highly symptomatic patients or in those with an aggressive pattern of venous drainage. However, this is a technically challenging approach associated with significant procedural morbidity. The authors present a case in which they decided to attempt a novel access to the cavernous sinus through the foramen ovale before recommending surgery for an otherwise untreatable dural CCF. This 52-year-old man with an indirect CCF and neurological deficit had undergone several attempts to embolize the shunt by means of the standard approaches. Ultimately direct cavernous sinus access was obtained through the foramen ovale, resulting in complete obliteration of the shunt. The occlusion was radiographically stable at the 6-month follow-up evaluation, and the patient has remained asymptomatic. Percutaneous transovale puncture of a CCF is a feasible alternative to accessing the cavernous sinus when traditional transvenous catheterization or direct superior ophthalmic vein approach is not possible.

scholarly journals Traumatic Carotid Cavernous Fistula: Failure of Endovascular Treatment with Two Stent-Grafts

2005 ◽  
Vol 11 (4) ◽  
pp. 369-375 ◽  
Author(s):  
G. La Tessa ◽  
L. Pasqualetto ◽  
G. Catalano ◽  
M. Marino ◽  
C. Gargano ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
High Flow ◽  
Stent Grafts ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Cavernous Fistula ◽  
Endovascular Approach ◽  
Stenting Procedure

We describe an unconventional endovascular approach in a young patient with large high-flow traumatic carotid cavernous fistula that could not be treated by detachable balloon procedure. Two coronary stent-grafts were used to close the large tear of internal carotid artery. After the failure of stenting procedure, the fistula was successfully treated by trapping with two detachable balloons.

scholarly journals Post-traumatic carotid-cavernous fistula with bilateral proptosis simulating cavernous sinus thrombosis

2019 ◽  
Vol 12 (3) ◽  
pp. e227757 ◽  
Author(s):  
Nirupama Kasturi ◽  
Pooja Kumari ◽  
Gayatri Nagarajan ◽  
Nagarajan Krishnan
Keyword(s):  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Cavernous Sinus Thrombosis ◽  
Coil Embolisation ◽  
Carotid Cavernous Fistula ◽  
Orbital Trauma ◽  
Cavernous Fistula ◽  
Intravenous Antibiotics ◽  
Post Traumatic

A 48-year-old woman presented with bilateral non-pulsatile proptosis and ophthalmoplegia after 3 days following blunt orbital trauma. It was associated with fever, malaise and loss of vision in right eye. She was provisionally diagnosed with cavernous sinus thrombosis and was treated with intravenous antibiotics with no improvement. A subtle bruit was present on examination, and digital subtraction angiography revealed a right direct (type A) carotid-cavernous fistula (CCF). The patient underwent right coil embolisation of direct CCF. On follow-up at 4 months, her proptosis resolved completely and extraocular movements improved.

Endovascular Occlusion of Traumatic Carotid Cavernous Fistula by Using Detachable Balloon in Various Ways: A Case Series

2017 ◽  
Vol 14 (02/03) ◽  
pp. 070-074
Author(s):  
Trilochan Srivastava ◽  
Shakir Husain ◽  
Ashok Gandhi ◽  
Virendra Sinha
Keyword(s):  
Ct Angiography ◽  
Local Anesthesia ◽  
Case Series ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Cavernous Fistula ◽  
Computed Tomographic ◽  
Endovascular Occlusion ◽  
Balloon Embolization

Abstract Introduction The detachable balloons are not frequently used nowadays for endovascular occlusion of carotid-cavernous fistula (CCF) because of lack of availability and supposed high risk of recurrence. This study describes the various way of detachable balloon embolization for traumatic CCF. Materials and Methods We have used endovascular detachable balloon to occlude the traumatic CCF under local anesthesia in various ways in 12 traumatic cases of CCF from March 2013 to April 2015. Clinical and computed tomographic (CT) angiography follow-up was done at 6 and 12 months. Results Clinical follow-up from 6 to 12 month showed persistent resolution of symptoms in 10 cases; 2 cases had developed slight proptosis and chemosis. CT angiography done in nine cases after 6 to 9 months showed no residual filling in CCF. Conclusion The detachable balloon either single or double with or without coils can be used in the management of CCF by different methods. Detachable balloon is a cheaper alternative compared with coiling. It is technically easier to perform and can be performed under local anesthesia.

Temporary Balloon Occlusion of the Cavernous Carotid Artery for Removal of an Orbital and Intracranial Foreign Body: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (5) ◽  
pp. E1240-E1243 ◽  
Author(s):  
Edwin J. Cunningham ◽  
Barbara Albani ◽  
Thomas J. Masaryk ◽  
Peter A. Rasmussen
Keyword(s):  
Foreign Body ◽  
Carotid Artery ◽  
Cavernous Sinus ◽  
Balloon Occlusion ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Angiography Suite ◽  
Cavernous Carotid Artery ◽  
Temporary Balloon Occlusion

Abstract OBJECTIVE AND IMPORTANCE: We describe the first reported use of temporary balloon occlusion of the cavernous internal carotid artery for controlled removal of a foreign object from the cavernous sinus. This endovascular approach may be an alternative to craniotomy in highly selected cases. CLINICAL PRESENTATION: A 34-year-old incarcerated male attempted suicide by stabbing the earpiece of his glasses through his right orbit into the intracranial compartment. He presented with complete ophthalmoplegia. The earpiece traversed the cavernous sinus, penetrating its posterior wall to enter the perimesencephalic cistern and cerebellum. Angiography demonstrated a small direct carotid-cavernous fistula. INTERVENTION: Removal of the foreign body was performed under general anesthesia in the angiography suite with the operating room on standby. Nondetachable and detachable balloons were inflated in the cavernous carotid artery to provide vascular control while the foreign body was withdrawn from the cranium at the orbit. Follow-up angiographic runs with the balloons deflated revealed minimal arteriovenous shunting, which disappeared on subsequent studies. The balloons were removed. The patient remained neurologically stable with his baseline right ophthalmoplegia and V1–V2 hemianesthesia. At the 6-week follow-up, the patient remained clinically stable with no evidence of carotid-cavernous fistula or interval abscess formation. CONCLUSION: Endovascular temporary balloon occlusion of the cavernous carotid artery provides immediate control of the vessel (with an option of permanent carotid sacrifice), allowing removal of a foreign body without craniotomy in appropriate cases.

Transvenous Embolisation of Spontaneous Carotid-Cavernous Fistulas by Sequential Occlusion of the Cavernous Sinus

1999 ◽  
Vol 5 (3) ◽  
pp. 225-234 ◽  
Author(s):  
K.-M. Cheng ◽  
C.-M. Chan ◽  
Y.-L. Cheung ◽  
C.-C. Liang ◽  
M.-K. Lee ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Clinical Cure ◽  
Venous Drainage ◽  
Clinical Results ◽  
Late Complications ◽  
Pathological Features ◽  
Cortical Venous Drainage ◽  
The Right ◽  
Carotid Cavernous Fistulas

There are two important pathological features associated with carotid-cavernous fistula (CCF): the retrograde cortical venous drainage that can cause intracranial haemorrhage and non haemorrhagic neurological deficit and the retrograde ophthalmic venous drainage that causes orbital venous congestion and visual impairment. We propose a sequential embolisation strategy by the selective occlusion of these two pathological features as the initial steps followed by occlusion of the rest of the cavernous sinus. Eight patients with spontaneous CCF were treated by transvenous embolisation using our embolisation strategy. The clinical features, angiographic findings, embolisation procedures, and clinical and angiographic outcomes were analyzed. The follow-up period ranged from one to 21 months. Clinical cure was achieved in six patients at one to two month follow-ups. One patient with bilateral CCFs had clinical cure of the right eye and clinical improvement of the left eye at three-month follow-up. Another patient had clinical cure at one-month follow-up except residual VI nerve palsy. Two patients had complete angiographic obliteration of the fistula immediately after the embolisation procedure. Another three patients underwent follow-up angiography at one to 16 months and all showed angiographic cure. There were no immediate or late complications. Our embolisation strategy offers a safe and effective option in the embolisation of spontaneous CCF as demonstrated by the clinical results of our eight patients.

scholarly journals Bilateral Persistent Pharyngo-Stapedial Arteries Revealed during Evaluation of a Carotid-Cavernous Fistula

2006 ◽  
Vol 12 (4) ◽  
pp. 327-334 ◽  
Author(s):  
J. Jehl ◽  
L. Jeunet ◽  
M. Berraiah ◽  
J.-F. Bonneville
Keyword(s):  
Carotid Cavernous Fistula ◽  
Spontaneous Thrombosis ◽  
Cavernous Fistula ◽  
Stapedial Artery ◽  
Temporal Bone Ct ◽  
Detachable Coils ◽  
Vascular Steal ◽  
The Right ◽  
High Degree

A 33-year-old woman was evaluated for a right carotid-cavernous fistula revealed by a proptosis and chemosis of the right eye. The initial angiogram showed a left persistent pharyngo-stapedial artery (Ph-SA). A temporal bone CT suggested bilateral pharyngo-stapedial artery persistence. The right Ph-SA was not opacified in the first angiogram because of the high degree of shunting in the fistula. Four months later the patient was admitted for treatment of the carotid-cavernous fistula. In the meantime, the fistula had altered, with spontaneous thrombosis of the ophthalmic vein, and decrease of the vascular steal, explaining that the right Ph-SA was clearly visible on the angiogram performed during the procedure. The carotid-cavernous fistula was completely occluded with five detachable coils. The follow-up included 3 Tesla MR angiography that showed complete closure of the fistula with preservation of the right ICA and bilateral persistent pharyngo-stapedial arteries.

scholarly journals Long Term Post Traumatic High Flow Carotid Cavernous Fistula with Patent Collateral Vessel : A Case Report

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Luthfy Farhan ◽  
Ridha Dharmajaya
Keyword(s):  
Case Report ◽  
Left Hemisphere ◽  
Cavernous Sinus ◽  
Craniocerebral Trauma ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Left Brain ◽  
History Of ◽  
Carotid Cavernous Sinus Fistula ◽  
The Right

Introduction : A carotid-cavernous sinus fistula (CCF) is an abnormal communication between arteries and veins within the cavernous sinus. Carotid cavernous fistula (CCF) is a very rare case it's difficult to diagnose. because most CCF patients rarely come for treatment. Case Report : A 33-year-old male presented with history of protrusion of Left eye ball, and double vision for the last 2 years. visual disturbances were found in the right eye for 2 years, blurry vision is increasingly. Bruit was audible in orbital region on the left side. DSA showed that there was a fistula in the left sinus cavernous region, the arteries in the left area showed inadequate to direct the left hemisphere, but in the right arety showed that the right artery was adversely affected right and left brain. Discussion : Traumatic CCFs are the most common type, accounting for up to 75% of all CCFs.87 They have been reported to occur in 0.2% of patients with craniocerebral trauma and in up to 4% of patients who sustain a basilar skull fractur.2 The symptoms and signs of CCF always include eyelid swelling, proptosis, chemosis, and hyperaemia, dilated of vessel and the condition is commonly misdiagnosed as Graves’ophthal-mopathy or inflammatory conjunctivitis.3Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of endovascular intervention in CCFs. Angiographic results in this patient showed a fistula in the left cavernous sinus and inadequate supply of the left artery to the left hemisphere. Conclusion : This case is very unique because the left brain gets blood supply from the right carotid system, with the left carotid artery system inadequate to direct the left hemisphere because of the carotid cavernous fistula on the left side

scholarly journals Transvenous embolization of dural carotid cavernous fistula through the facial and ophthalmic vein

2011 ◽  
Vol 68 (12) ◽  
pp. 1079-1083 ◽  
Author(s):  
Branko Prstojevic ◽  
Mirko Micovic ◽  
Ivan Vukasinovic ◽  
Mirjana Nagulic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
The Right ◽  
Transvenous Approach

Introduction. Dural carotid cavernous fistula is acquired, relatively rare, condition comprising of numerous smallcaliber meningeal arterial branches, draining directly into cavernous sinus. Endovascular therapy is the treatment of choice, preferably by a transvenous approach. In the case of inaccessible inferior petrosal sinus, other alternative routes are considered. We presented a case of dural carotid cavernous fistula completely occluded with Guglielmi detachable coils, using a transvenous approach through facial and superior ophthalmic vein. Case report. A 62-year-old man was referred with a gradual worsening proptosis, red eye, and decreased visual acuity, on the right side. Digital subtraction angiography revealed the presence of a right dural carotid cavernous fistula, predominantly supplied from dural branches of the right internal carotid artery siphon, with minimal contribution from the right middle meningeal artery and contralateral dural branches of the left internal carotid artery siphon. The fistula was drainaged through the dilated superior ophthalmic vein, and via the facial to the internal jugular vein. There was neither pacification of pterygoid and petrous sinuses, nor cortical venous reflux. Endovascular treatment was performed by a transvenous approach. A guiding catheter was placed in the right facial vein. A microcatheter was advanced through the dilated angular and superior ophthalmic vein, and its tip positioned into the right cavernous sinus. Coils were deployed, until a complete angiographic occlusion of the fistula had been achieved. The patient experienced rapid improvement in the symptoms, with complete normalization of his condition one month after the treatment. Conclusion. Coil embolization of dural carotid cavernous fistula by transvenous catheterization, through the facial and superior ophthalmic vein, can be considered as safe and effective treatment option in the presence of marked anterior drainage.

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