Fatal intracranial hemorrhage after balloon occlusion of an extracranial vertebral arteriovenous fistula

1988 ◽  
Vol 69 (6) ◽  
pp. 945-948 ◽  
Author(s):  
Takeshi Kondoh ◽  
Norihiko Tamaki ◽  
Naoya Takeda ◽  
Touru Suyama ◽  
Shizuo Oi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Arteriovenous Fistula ◽  
Balloon Occlusion ◽  
Retrograde Flow ◽  
Hemodynamic Effects ◽  
Arteriovenous Fistulae ◽  
Content Type ◽  
Vertebral Arteriovenous Fistula ◽  
Fatal Hemorrhage ◽  
Fine Print

✓ A patient is presented who developed a fatal hemorrhage immediately after balloon occlusion of an extracranial vertebral arteriovenous fistula. The fistula was associated with marked retrograde flow not only from the contralateral vertebral artery but also from the carotid artery system through the posterior communicating artery and the basilar artery. The bleeding appeared to be caused by acute hemodynamic effects following abrupt occlusion of the long-standing fistula. A gradual staged occlusion or trapping procedure should be considered for the treatment of such vertebral arteriovenous fistulae.

Traumatic arteriovenous fistula of the vertebral artery with spinal cord symptoms

1977 ◽  
Vol 46 (5) ◽  
pp. 681-687 ◽  
Author(s):  
Chikao Nagashima ◽  
Takashi Iwasaki ◽  
Seiichi Kawanuma ◽  
Arata Sakaguchi ◽  
Akira Kamisasa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Rapid Improvement ◽  
Direct Closure ◽  
Content Type ◽  
Vertebral Arteriovenous Fistula ◽  
Fine Print

✓ The authors report a case of a traumatic vertebral arteriovenous fistula with spinal cord symptoms. Direct closure of the fistula was followed by rapid improvement.

Excision of a congenital suboccipital vertebral arteriovenous fistula

1972 ◽  
Vol 37 (4) ◽  
pp. 452-456 ◽  
Author(s):  
Albert D. Bartal ◽  
Morris J. Levy
Keyword(s):  
Arteriovenous Malformation ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Surgical Approach ◽  
Left Ventricular ◽  
Content Type ◽  
Vertebral Arteriovenous Fistula ◽  
Cardiac Enlargement ◽  
Major Consideration ◽  
Fine Print

✓ This report describes the successful excision of a congenital vertebral arteriovenous malformation in an 8-year-old child. There was mild effort dyspnea and left ventricular cardiac enlargement; a left-to-right vertebral artery steal across the basilar trifurcation was a major consideration in planning the surgical approach.

Trigeminal artery to cavernous sinus fistula treated by balloon occlusion

1983 ◽  
Vol 58 (4) ◽  
pp. 611-613 ◽  
Author(s):  
Charles W. Kerber ◽  
William Manke
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Femoral Artery ◽  
Balloon Occlusion ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Content Type ◽  
Flow Through ◽  
Sinus Flow ◽  
Fine Print

✓ A spontaneous cavernous sinus fistula developed following presumed sinusitis, and was found to originate not from the carotid artery but from a persistent trigeminal artery. The fistula was treated by introducing a detachable latex balloon via a femoral artery approach through the trigeminal artery and then into the cavernous sinus. Flow through the carotid, vertebral, and trigeminal arteries was preserved.

Balloon occlusion of a spontaneous fistula of the posterior inferior cerebellar artery

1983 ◽  
Vol 58 (2) ◽  
pp. 287-290 ◽  
Author(s):  
Fernando Viñuela ◽  
Allan J. Fox ◽  
Shinichi Kan ◽  
Charles G. Drake
Keyword(s):  
Arteriovenous Fistula ◽  
Posterior Inferior Cerebellar Artery ◽  
Mass Effect ◽  
Balloon Occlusion ◽  
Cerebellar Syndrome ◽  
Detachable Balloon ◽  
Content Type ◽  
Cerebellar Artery ◽  
Fistula Site ◽  
Fine Print

✓ A case is reported of a large spontaneous right posterior inferior cerebellar artery fistula in which the patient presented with a right cerebellopontine (CP) angle and right cerebellar syndrome. The patient was successfully treated by balloon occlusion at the fistula site. The location of the arteriovenous fistula, the mass effect of its enlarged draining veins on the cerebellum and CP angle structures, and the simple therapeutic endovascular occlusion with a detachable balloon make this case unique.

Spontaneous extracranial vertebral arteriovenous fistula with fibromuscular dysplasia

1981 ◽  
Vol 54 (3) ◽  
pp. 399-402 ◽  
Author(s):  
S. V. Ramana Reddy ◽  
William E. Karnes ◽  
Franklin Earnest ◽  
Thoralf M. Sundt
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Cervical Myelopathy ◽  
Fibromuscular Dysplasia ◽  
Content Type ◽  
Vertebral Arteriovenous Fistula ◽  
Fine Print

✓ A case of spontaneous vertebral arteriovenous fistula in association with fibromuscular dysplasia is reported. The patient presented with progressive cervical myelopathy and cervical bruit. The pathogenesis of the fistula development and the spinal cord symptoms is discussed. Symptoms subsided after obliteration of the fistula.

Emergency balloon occlusion for massive epistaxis due to traumatic carotid-cavernous aneurysm

1988 ◽  
Vol 68 (1) ◽  
pp. 142-144 ◽  
Author(s):  
Richard K. Simpson ◽  
Richard L. Harper ◽  
R. Nick Bryan
Keyword(s):  
Head Injury ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
Traumatic Aneurysm ◽  
Acute Hemorrhage ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A patient with a giant traumatic aneurysm of the right internal carotid artery presented with recurrent massive epistaxis 30 years after a head injury. During an episode of acute hemorrhage, this patient was effectively treated with occlusion of the internal carotid artery circulation by a detachable inflatable balloon.

Proximal intracranial internal carotid artery branches: prevalence and importance for balloon occlusion test

2005 ◽  
Vol 102 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Jason W. Allen ◽  
Anthony J. G. Alastra ◽  
Peter K. Nelson
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
Content Type ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
The Right ◽  
Fine Print

Object. The aim of this study was to determine the prevalence of angiographically identifiable skull base arterial branches that potentially serve as collateral conduits during a balloon occlusion test (BOT) of the internal carotid artery (ICA). The authors posited that neurological deficits in patients who had previously tolerated the occlusion test may be attributable to an unrecognized collateral support through these channels (operant during proximal ICA BOT) when permanent ICA occlusion was performed more distally. Methods. In 481 cases (962 ICAs), cerebral angiograms obtained during routine Wada testing were retrospectively reviewed. Two hundred sixty-one patients had at least one angiographically identifiable ICA branch; 109 patients had two or more branches. A meningohypophyseal branch of the cavernous ICA was identified on the right side in 108 patients and on the left in 122. A vidian artery originated from the petrous portion of the ICA on the right side in 58 patients and on the left in 85. The inferolateral trunk revealed itself as a branch of the cavernous ICA on the right side in 17 patients and on the left in 33. A caroticotympanic artery arose from a left cavernous ICA. A persistent trigeminal artery was situated on the right side in two patients and on the left in three. More than half of the patients had angiographically identifiable and perhaps hemodynamically significant skull base branches of the ICA, and approximately one quarter had more than one identifiable branch. Conclusions. The authors recommend that patients be screened during angiography studies performed prior to BOT in branches of the proximal intracranial ICA and that the site of BOT be moved distally if such branches are identified.

Prediction of tolerance to carotid artery occlusion using transcranial Doppler ultrasound

1994 ◽  
Vol 81 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Cole A. Giller ◽  
Dana Mathews ◽  
Brandy Walker ◽  
Philip Purdy ◽  
Angie M. Roseland
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Transcranial Doppler ◽  
Transcranial Doppler Ultrasound ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Balloon Occlusion ◽  
Content Type ◽  
Carotid Artery Compression ◽  
Fine Print

✓ Surgical sacrifice of the carotid artery is a frequently anticipated event during the treatment of certain aneurysms and tumors. The ability to predict tolerance to carotid artery occlusion is therefore of benefit when planning procedures in which the carotid artery is at risk. A trial of carotid artery occlusion using an angiographic balloon during concurrent neurological examination or blood flow studies is an accepted method for testing tolerance, but it carries the risks of an angiogram and cannot be performed at the bedside. Transcranial Doppler ultrasound (TCD) is a noninvasive modality that permits measurement of blood velocity in cerebral vessels. The immediate effects of carotid artery occlusion on middle cerebral artery (MCA) perfusion can be obtained by insonating this artery during manual carotid artery compression. To compare the TCD response to carotid artery compression with the data obtained with more formal testing, the MCA of 22 patients was insonated during manual carotid artery compression and the results compared with the clinical tolerance to balloon occlusion in all patients and to blood flow studied by single photon emission computerized tomography before or during balloon occlusion in 14 of the 22 patients. Surgery was planned to treat giant unruptured aneurysms in 17 cases, intracranial tumors in three, a carotid-cavernous fistula in one, and a carotid artery injury in one. Fifteen patients showed a reduction in TCD flow velocities by no more than 65%; of these, 14 (93%) clinically tolerated the balloon occlusion test. Of the seven patients showing a TCD flow velocity decrease of more than 65%, six (86%) developed a transient focal deficit during the occlusion. It is concluded that the change in MCA velocity measured with TCD studies during manual carotid artery occlusion is a useful predictor of the clinical and blood flow responses to a trial of carotid artery occlusion with an angiographic balloon.

Venous rupture during transvenous approach to a carotid-cavernous fistula

1989 ◽  
Vol 71 (1) ◽  
pp. 133-137 ◽  
Author(s):  
Wesley A. King ◽  
Grant B. Hieshima ◽  
Neil A. Martin
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Balloon Occlusion ◽  
Alternative Methods ◽  
Ocular Motility ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
A Minor ◽  
Transvenous Approach

✓ An attempt at transfemoral transarterial balloon occlusion of a high-flow spontaneous carotid-cavernous fistula was unsuccessful because the carotid artery rent was too small for this approach. During a subsequent transvenous approach to the cavernous sinus through the jugular vein, the inferior petrosal sinus was perforated. A minor subarachnoid hemorrhage occurred before the tear could be sealed by the deposition of three Gianturco coils in the vein. The patient was taken to the operating room for emergency obliteration of the fistula and petrosal sinus in order to remove the risk of further hemorrhage. Under the guidance of intraoperative digital subtraction angiography, isobutyl-2-cyanoacrylate was injected directly into the surgically exposed cavernous sinus. Successful obliteration of the fistula was achieved with preservation of the carotid artery, and the angiography catheter was removed safely from the petrosal sinus. Although initially after surgery the patient had nearly complete ophthalmoplegia, at her 1-year follow-up examination she had normal ocular motility and visual acuity. The transvenous approach to the cavernous sinus and alternative methods of treatment of carotid-cavernous fistulas are discussed.

Ruptured intracranial aneurysms in the first two decades of life

1971 ◽  
Vol 35 (5) ◽  
pp. 571-576 ◽  
Author(s):  
Aneel N. Patel ◽  
Alan E. Richardson
Keyword(s):  
Carotid Artery ◽  
Intracranial Aneurysms ◽  
Postmortem Examination ◽  
Surgical Mortality ◽  
Terminal Portion ◽  
Good Tolerance ◽  
Content Type ◽  
Intracranial Operation ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ An analysis of 3000 ruptured intracranial aneurysms revealed 58 cases in patients under the age of 19 years. There was a striking incidence of aneurysms of the carotid termination and anterior cerebral complex, accounting for 43 of 58 cases, and of these 20 involved the terminal portion of the carotid artery. Vasospasm occurred slightly less often than in adults and infarction was only seen in one postmortem examination. The surgical mortality in alert patients was 7% whereas in a comparable bedrest group it was 38%. This good tolerance to surgery was evident whether intracranial operation or carotid ligation was used, but the surgical method was not randomly allocated.

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