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 Spontaneous Resolution of Post-Traumatic Direct Carotid-Cavernous Fistula

2017 ◽  
Vol 7 (1-2) ◽  
pp. 1-5 ◽  
Author(s):  
Varun Naragum ◽  
Glenn Barest ◽  
Mohamad AbdalKader ◽  
Katharine M. Cronk ◽  
Thanh N. Nguyen
Keyword(s):  
Carotid Artery ◽  
Endovascular Embolization ◽  
High Flow ◽  
Spontaneous Resolution ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Post Traumatic ◽  
Cavernous Carotid Artery ◽  
Carotid Cavernous Fistulas ◽  
Direct Carotid Cavernous Fistula

Post-traumatic carotid-cavernous fistulas are due to a tear in the wall of the cavernous carotid artery, leading to shunting of blood into the cavernous sinus. These are generally high-flow fistula and rarely resolve spontaneously. Most cases require endovascular embolization. We report a case of Barrow type A carotid-cavernous fistula which resolved spontaneously.

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.

scholarly journals Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies Study of 172 Cases

2014 ◽  
Vol 20 (4) ◽  
pp. 461-475 ◽  
Author(s):  
Cuong Tran Chi ◽  
Dang Nguyen ◽  
Vo Tan Duc ◽  
Huynh Hong Chau ◽  
Vo Tan Son
Keyword(s):  
Carotid Artery ◽  
Treatment Strategies ◽  
Type A ◽  
Endovascular Embolization ◽  
Endovascular Intervention ◽  
Medium Size ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Cavernous Fistula ◽  
Large Size

We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced sacrifice of the parent vessels and it was associated with sizes of the fistula. Total severe complication was about 2.4% which included 1 death (0.6%) due to vagal shock; 1 transient hemiparesis post-sacrifice occlusion of the carotid artery but the patient had recovered after 3 months; 1 acute thrombus embolism and the patient was completely saved with recombinant tissue plaminogen activator (rTPA); 1 balloon dislodgement then got stuck at the anterior communicating artery but the patient was asymptomatic. Endovascular intervention as the treatment of direct traumatic CCF had high cure rate and low complication with its ability to preserve the carotid artery. It also can supply flexible accesses to the fistulous site with various alternative embolic materials. The new classification of type A CCF based on angiographic features was helpful for planning for the embolization. Coil should be considered as the first embolic material for small size fistula meanwhile detachable balloons was suggested as the first-choice embolic agent for the medium and large size fistula.

scholarly journals Low-Flow Direct Carotid-Cavernous Fistula Caused by Rupture of an Intracavernous Carotid Aneurysm

2014 ◽  
Vol 20 (4) ◽  
pp. 476-481 ◽  
Author(s):  
I-Chang Su ◽  
Juan Pablo Cruz ◽  
Timo Krings
Keyword(s):  
Rare Case ◽  
High Flow ◽  
Low Flow ◽  
Clinical Scenario ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Carotid Cavernous Fistulas ◽  
Direct Carotid Cavernous Fistula

Direct carotid-cavernous fistulas (CCFs) secondary to a ruptured intracavernous carotid aneurysm (ICCA) are usually high-flow lesions. On very rare occasions, a ruptured ICCA may present as a low-flow CCF, which poses a diagnostic and therapeutic dilemma whether the aneurysm and the observed fistula are causally related. Herein, we describe a rare case in which a ruptured ICCA resulted in a low-flow CCF. We demonstrated our approach to clarify this clinical scenario, and also propose a possible pathomechanism to explain the existence of low-flow direct CCF.

scholarly journals Use of coronary stent grafts for the treatment of high-flow carotid cavernous fistula

2021 ◽  
Vol 14 (11) ◽  
pp. e245922
Author(s):  
Ivo Petrov ◽  
Zoran Stankov ◽  
Damyan Boychev ◽  
Marko Klissurski
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
High Flow ◽  
Coronary Stent ◽  
Parent Artery ◽  
Covered Stents ◽  
Stent Grafts ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Carotid Cavernous Fistulas

Carotid cavernous fistulas are abnormal communications between the carotid artery or its branches and the cavernous sinus. It can be traumatic or spontaneous. The widely accepted treatment is by detachable balloons. Advancements in the field of endovascular medicine made available other options for the treatment of this condition. Covered stents are widely available and offer preservation of the parent artery while occluding the fistula.

scholarly journals Intra-Arterial Lidocaine Blunts the Trigeminocardiac Reflex during Endovascular Treatment of a Carotid-Cavernous Fistula

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Renee L. Coleman ◽  
Dmitri Bezinover ◽  
Douglas C. Jones ◽  
Kevin M. Cockroft ◽  
Uma R. Parekh
Keyword(s):  
Case Report ◽  
Cavernous Sinus ◽  
Hemodynamic Instability ◽  
Endovascular Embolization ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Trigeminocardiac Reflex ◽  
Intraoperative Management ◽  
Carotid Cavernous Fistulas ◽  
Neurovascular Structures

Carotid-cavernous fistulas (CCFs) are vascular shunts that allow blood to flow from the carotid artery or its branches into the cavernous sinus. Endovascular embolization is the treatment modality of choice. The trigeminocardiac reflex (TCR) is a vagally mediated reflex that can lead to hemodynamic instability. It can be activated during embolization procedures due to the proximity of vagal efferent neurovascular structures within the cavernous sinus. This case report describes the intraoperative management of recurrent, profound bradycardia due to TCR during endovascular CCF embolization.

scholarly journals Direct Carotid-Cavernous Fistula with early drainage into inferior petrous sinus

2021 ◽  
Vol 29 ◽  
pp. 1-9
Author(s):  
Olavo Leite de Macêdo Neto ◽  
Amanda Menezes Morgado ◽  
Rafael Dos Santos Araujo ◽  
José Silva Souza ◽  
Ana Carla Da Silva Mendes ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
The Third ◽  
The Right ◽  
Carotid Cavernous Fistulas ◽  
Direct Carotid Cavernous Fistula

Carotid-cavernous fistulas (CCF) are classified in direct (Barrow A) and indirect. The direct comunication between the cavernous segment of the internal carotid artery and the cavernous sinus defines direct CCF. In the present case, is described a 51-year-old female patient, diagnosed with subarachnoid hemorrhage through head tomography. The patient underwent an agiographic study, wen was identified a large dissecant aneurysm in the right internal carotid artery and a direct CCF with early drainage into the ophthalmic vein and inferior petrous sinus, manifesting paralysis of the third cranial nerve.

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 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.

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