Endovascular Treatment of Intracranial Dural Arteriovenous Fistulae Using Onyx: a Case Series

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. ons132-ons140 ◽  
Author(s):  
Michael F. Stiefel ◽  
Felipe C. Albuquerque ◽  
Min S. Park ◽  
Shervin R. Dashti ◽  
Cameron G. McDougall
Keyword(s):  
Carotid Artery ◽  
Transarterial Embolization ◽  
Case Series ◽  
Middle Meningeal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Arteriovenous Fistulae ◽  
Meningeal Artery

Abstract Objective: An endovascular approach is often the first-line treatment of dural arteriovenous fistulae (DAVFs). Information on the use of Onyx (ev3 Neurovascular, Irvine, CA) for treating DAVFs, however, is limited. Therefore, we present our early experience, technical considerations, and complications associated with the use of Onyx for DAVF embolization. Methods: Twenty-eight patients with 29 DAVFs treated with Onyx embolization were included in this analysis. Hospital records, operative reports, and angiograms were reviewed and analyzed. Results: Forty Onyx procedures, including 39 transarterial and 1 transvenous approaches, were performed. Fifty-one external carotid artery branches, 8 posterior meningeal artery branches, and 3 internal carotid artery branches were used for Onyx embolization. Branches of the middle meningeal artery were embolized 32 times, and the occipital artery was embolized 15 times. Twenty-one fistulae (72%) were cured angiographically with endovascular therapy. Transarterial embolization via the middle meningeal artery cured 12 DAVFs (41%). Four complications (9.7%) were recorded, including 3 transient (7.3%) and 1 permanent neurological deficits (2.4%). Follow-up imaging, which was available for 8 fistulae with angiographic cures, showed no evidence of recurrence. Conclusion: Transarterial Onyx embolization of external carotid artery branches, particularly the middle meningeal artery, offers a high likelihood of cure. This technique provides a safe and effective method of embolization with few side effects and complications. However, long-term follow-up is needed to establish its efficacy.

scholarly journals Retinal Embolization and Cerebellar Asymptomatic Embolization after Carotid Stenting Using Distal Balloon Protection

2003 ◽  
Vol 9 (3) ◽  
pp. 311-314 ◽  
Author(s):  
S. Islam ◽  
H. Manabe ◽  
S. Hasegawa ◽  
A. Takemura ◽  
M. Nagahata ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ophthalmic Artery ◽  
Carotid Stenting ◽  
External Carotid Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Cerebral Embolization ◽  
Intracranial Arteries ◽  
Balloon Protection ◽  
Meningeal Artery

We describe a rare case of having both symptomatic ipsilateral retinal embolization and asymptomatic cerebellar embolization occurring after carotid stenting with use of distal protect device. In this case, external carotid angiograms revealed accessory meningeal artery-ophthalmic artery and occipital artery-vertebral artery anastomoses. This case suggested that the protection for external carotid artery should be considered during carotid stenting to avoid retinal embolization and cerebellar or cerebral embolization in cases showing angiographical anastomoses between external carotid artery and ophthalmic artery or intracranial arteries.

scholarly journals Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

2020 ◽  
Vol 54 (3) ◽  
pp. 253-262
Author(s):  
Crt Langel ◽  
Dimitrij Lovric ◽  
Ursa Zabret ◽  
Tomislav Mirkovic ◽  
Primoz Gradisek ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Injury Severity ◽  
Transarterial Embolization ◽  
Treatment Options ◽  
Case Series ◽  
External Carotid Artery ◽  
Maxillofacial Trauma ◽  
External Carotid ◽  
Severe Bleeding ◽  
Life Threatening

AbstractBackgroundSevere bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce.Patients and methodsPubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories.Results and conclusionsBased on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.

scholarly journals Left temporal craniotomy and direct microcatheterization of the middle meningeal artery for treatment of a complex temporal dural arteriovenous fistula

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V8
Author(s):  
Daniel M. S. Raper ◽  
Nasser Mohammed ◽  
M. Yashar S. Kalani ◽  
Min S. Park
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Treatment Approach ◽  
Transarterial Embolization ◽  
Middle Meningeal Artery ◽  
Intraoperative Angiography ◽  
Arteriovenous Fistulae ◽  
Posterior Division ◽  
Technical Considerations ◽  
Meningeal Artery

The preferred method for treating complex dural arteriovenous fistulae of the transverse and sigmoid sinuses is via endovascular, transarterial embolization using liquid embolysate. However, this treatment approach mandates access to distal dural feeding arteries that can be technically challenging by standard endovascular approaches. This video describes a left temporal craniotomy for direct stick microcatheterization of an endovascularly inaccessible distal posterior division of the middle meningeal artery for embolization of a complex left temporal dural arteriovenous fistula. The case was performed in the hybrid operative suite with biplane intraoperative angiography. Technical considerations, operative nuances, and outcomes are reviewed.The video can be found here: https://youtu.be/Dnd4yHgaKcQ.

Selective Occipital Artery Sonography for Dural Arteriovenous Fistulas

2012 ◽  
Vol 25 (2) ◽  
pp. 212-216
Author(s):  
K. Kono ◽  
M. Mori ◽  
Y. Wakugawa ◽  
M. Yasaka ◽  
Y. Okada ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Resistance Index ◽  
Duplex Sonography ◽  
External Carotid Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Arteriovenous Fistulas ◽  
Carotid Duplex ◽  
Dural Arteriovenous Fistulas ◽  
Artery Detection

Carotid duplex sonography is a useful method for evaluation of dural arteriovenous fistulas. The resistance index of the external carotid artery has been reported to correlate with the efficacy of treatment and recurrence or aggravation of dural arteriovenous fistulas. Herein, we describe a case of dural arteriovenous fistulas mainly supplied by the occipital artery and show that the resistance index of the occipital artery was more sensitive than that of the external carotid artery. To the best of our knowledge, this is the first report to describe the feasibility of occipital artery detection by carotid duplex sonography and clinical application of the resistance index of the occipital artery for dural arteriovenous fistulas.

Revascularization and Aneurysm Surgery

Neurosurgery ◽  
2014 ◽  
Vol 74 (5) ◽  
pp. 482-498 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Wyatt Ramey ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Aneurysm Surgery ◽  
Cerebellar Artery

Abstract BACKGROUND: Given advances in endovascular technique, the indications for revascularization in aneurysm surgery have declined. OBJECTIVE: We sought to define indications, outline technical strategies, and evaluate the outcomes of patients treated with bypass in the endovascular era. METHODS: We retrospectively reviewed all aneurysms treated between September 2006 and February 2013. RESULTS: We identified 54 consecutive patients (16 males and 39 females) with 56 aneurysms. Aneurysms were located along the cervical internal carotid artery (ICA) (n = 1), petrous/cavernous ICA (n = 1), cavernous ICA (n = 16), supraclinoid ICA (n = 7), posterior communicating artery (n = 2), anterior cerebral artery (n = 4), middle cerebral artery (MCA) (n = 13), posterior cerebral artery (PCA) (n = 3), posterior inferior cerebellar artery (n = 4), and vertebrobasilar arteries (n = 5). Revascularization was performed with superficial temporal artery (STA) to MCA bypass (n = 25), STA to superior cerebellar artery (SCA) (n = 3), STA to PCA (n = 1), STA-SCA/STA-PCA (n = 1), occipital artery (OA) to PCA (n = 2), external carotid artery/ICA to MCA (n = 15), OA to MCA (n = 1), OA to posterior inferior cerebellar artery (n = 1), and in situ bypasses (n = 8). At a mean clinical follow-up of 18.5 months, 45 patients (81.8%) had a good outcome (Glasgow Outcome Scale 4 or 5). There were 7 cases of mortality (12.7%) and an additional 9 cases of morbidity (15.8%). At a mean angiographic follow-up of 17.8 months, 14 bypasses were occluded. Excluding the 7 cases of mortality, the majority of aneurysms (n = 42) were obliterated. We identified 7 cases of residual aneurysm and recurrence in 6 patients at follow-up. CONCLUSION: Given current limitations with existing treatments, cerebral revascularization remains an essential technique for aneurysm surgery.

scholarly journals Surgical management of superior petrosal sinus dural arteriovenous fistulae with dominant internal carotid artery supply

2018 ◽  
Vol 24 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Christopher J Stapleton ◽  
Anoop P Patel ◽  
Brian P Walcott ◽  
Collin M Torok ◽  
Matthew J Koch ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
High Rate ◽  
External Carotid ◽  
Arteriovenous Fistulae ◽  
Surgical Closure ◽  
Superior Petrosal Sinus

Background While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed. Results Within this cohort, eight patients with nine SPS DAVF were eligible for evaluation. Five DAVF were initially treated with endovascular embolization, while four underwent surgical occlusion without embolization. Of the SPS DAVF treated with embolization, two (40%) remained occluded on follow-up, while the remaining three (60%) persisted/recurred and required surgical intervention for definitive closure. Of the four SPS DAVF treated with primary surgical occlusion, all four (100%) remained closed on follow-up. In addition, of the three SPS DAVF that persisted/recurred following embolization and required subsequent surgical closure, all three (100%) remained occluded on follow-up. Two (100%) SPS DAVF that were successfully treated with embolization had major or minor external carotid artery supply, while the three (100%) persistent lesions had major ICA supply via the meningohypophyseal trunk (MHT). Three (75%) of the four SPS DAVF treated with primary surgical occlusion had dominant MHT supply. Conclusion Complete endovascular closure of SPS DAVF with dominant ICA supply via the MHT may be difficult to achieve, while upfront surgical intervention is associated with a high rate of complete occlusion.

Spontaneous opening of large occipital-vertebral artery anastomosis during embolization

1980 ◽  
Vol 53 (6) ◽  
pp. 849-850 ◽  
Author(s):  
Robert F. Spetzler ◽  
Michael Modic ◽  
Charles Bonstelle
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Therapeutic Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Dural Arteriovenous Malformation ◽  
Artery Embolization ◽  
Content Type ◽  
Fluoroscopic Control

✓ A patient undergoing external carotid artery therapeutic embolization for obliteration of a dural arteriovenous malformation suddenly developed a large occipital artery to vertebral artery shunt. A devastating stroke was averted because the appearance of the shunt was observed by fluoroscopy, the embolization was stopped, and the shunt verified on a subsequent angiogram. The risk of external carotid artery embolization without constant fluoroscopic control is emphasized.

Direct carotid sinus approach to treatment of bilateral carotid-cavernous fistulas

1988 ◽  
Vol 69 (6) ◽  
pp. 942-944 ◽  
Author(s):  
Pedro Albert ◽  
Manuel Polaina ◽  
Francisco Trujillo ◽  
José Romero
Keyword(s):  
Carotid Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Lateral Sinus ◽  
Direct Puncture ◽  
Content Type ◽  
Bilateral Carotid ◽  
The Right ◽  
Carotid Cavernous Fistulas

✓ The authors present a patient with a complex vascular malformation composed of bilateral spontaneous carotid-cavernous fistulas (CCF's). The abnormality was supplied on the right side by the right external carotid artery (ECA) and the right internal carotid artery (ICA), and on the left side only by the left ICA. There was also an arteriovenous communication between the right ECA and the lateral sinus. Surgical embolization of both cavernous sinuses with oxidized cellulose was achieved on one side by direct puncture and on the other through one of its venous affluents, successfully occluding both CCF's and preserving the patency of both ICA's without any neurological deficit. The arteriovenous communication between the right ECA and the lateral sinus was occluded by embolization of the occipital artery and ligation of the right ECA.

Vertebral Artery Disease

Neurosurgery ◽  
1981 ◽  
Vol 9 (5) ◽  
pp. 524-530 ◽  
Author(s):  
Michael B. Pritz ◽  
William F. Chandler ◽  
Glenn W. Kindt
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Medical Management ◽  
Posterior Inferior Cerebellar Artery ◽  
External Carotid Artery ◽  
The Other ◽  
External Carotid ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Artery Disease

Abstract The neuroradiological evaluation, perioperative medical management, and microsurgical treatment of variously located vertebral artery lesions are presented. Four types of surgical procedures were undertaken: proximal vertebral artery to common carotid artery end-to-side anastomosis; external carotid artery to midcervical vertebral artery end-to-side anastomosis; external carotid artery to distal cervical vertebral artery end-to-end anastomosis; and occipital artery to posterior inferior cerebellar artery end-to-side anastomosis. Each case is used to demonstrate the evaluation and management involved, the type of and rationale for the surgical procedure selected, and the patency of the anastomosis performed. Two points are emphasized. One is that, after careful angiographic evaluation and improved perioperative medical management, lesions of the vertebral artery are indeed amenable to microsurgical intervention with relatively low risk to the patient. The other is that, whenever possible, anastomosis of the largest caliber of vessels with the least number of suture lines is the surgical treatment of choice.

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