4D flow preliminary investigation of a direct carotid cavernous fistula due to a ruptured intracavernous aneurysm

Nakagawa, Shunsuke; Murai, Yasuo; Wada, Takeshi; Tateyama, Kojiro

doi:10.1136/bcr-2014-206084

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…We encountered a patient with PH due to isolated pulmonary artery involvement in large-vessel vasculitis, and evaluated the perioperative hemodynamic changes using 4D-flow MRI. Such perioperative assessments have been reported in cardiovascular and cerebrovascular diseases, and have demonstrated the importance of hemodynamic changes in surgical planning or therapeutic effects [1], [2], [3], [4], [5], [6], [7], [8], [9]. In patients with PH, Reiter et al demonstrated a relationship between mean PAP and vortical blood flow in the main pulmonary artery [1].…”

Section: Discussionmentioning

confidence: 96%

4D-flow MRI assessment of blood flow before and after endovascular intervention in a patient with pulmonary hypertension due to isolated pulmonary artery involvement in large vessel vasculitis

Kamada

Ota

Aoki

et al. 2020

Radiology Case Reports

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A 43-year-old woman presented with dyspnea during exertion and lower leg edema. Contrast-enhanced computed tomography images demonstrated extensive proximal narrowing in the right main pulmonary artery with thickening and enhancement. Right heart catheterization revealed the presence of precapillary pulmonary hypertension with a mean pulmonary arterial pressure of 45 mm Hg. The patient was diagnosed with large-vessel vasculitis with isolated pulmonary artery involvement. Takayasu's arteritis was suspected, but histological examination was not performed. Several sessions of pulmonary arterial intervention were stratified for the right main pulmonary artery. After treatment, mean pulmonary arterial pressure had decreased to 22 mm Hg with improvement in symptoms. Thoracic 4D-flow magnetic resonance imaging was performed before and after intervention to evaluate the volume flow rates of pulmonary arteries. The rates increased at the inlet of the right pulmonary artery (before: 23 mL/s vs after: 47.5 mL/s) and the main pulmonary artery (before: 71.2 mL/s vs after: 82.5 mL/s), and decreased at the inlet of the left pulmonary artery (before: 46.2 mL/s vs after: 31.7 mL/s). The split ratio of volume flow rate between the right and left pulmonary arteries improved after treatment (before. right:left = 33.1:66.9; after, right:left = 60.0:40.0), approaching normal values. This report quantitatively describes perioperative hemodynamic changes in a patient with pulmonary hypertension using 4D-flow magnetic resonance imaging. Stent placement for stenosis in the right pulmonary artery resulted in an increase in overall pulmonary blood flow and also improved blood flow balance between the right and the left pulmonary arteries.

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Section: Discussionmentioning

confidence: 96%

4D-flow MRI assessment of blood flow before and after endovascular intervention in a patient with pulmonary hypertension due to isolated pulmonary artery involvement in large vessel vasculitis

Kamada

Ota

Aoki

et al. 2020

Radiology Case Reports

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“…The ICA occlusion rate with endovascular treatment is ranging from 17% to 47%. [ 20 ] Endovascular internal trapping is performed in cases with retrograde dome filling from collateral flow observed during BOT or if the aneurysm is extended to the bifurcation of the ophthalmic artery. In other cases, proximal ICA ligation is preferred.…”

Section: Discussionmentioning

confidence: 99%

“…A direct aneurysmal CCF was successfully treated by high-flow bypass using a RAG and ICA trapping in one case report. [ 20 ] Another study also found that high-flow bypass with aneurysm trapping is the appropriate surgical treatment to obliterate the fistula immediately in cases of CCA presented with direct CCF. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

High-flow bypass with radial artery graft for cavernous carotid aneurysms: A case series

et al. 2020

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Background: The incidence of cavernous carotid aneurysms (CCAs) of intracranial aneurysms is low. Majority of cases presented as incidental findings with benign natural progression. The most common presenting symptoms are multiple cranial neuropathies among symptomatic patients. The treatment modalities for symptomatic patients include direct surgical clipping, endovascular coil embolization, or placement of flow diverter, or indirect procedures such as occlusion of parent artery with and without revascularization techniques. The advancement in the microsurgical treatments and endovascular devices have enable a high success rate in the treatment of patients with CCAs with low morbidity and mortality rates. Objective: To study the surgical outcomes of patients with cavernous aneurysm who underwent high-flow bypass between 2015 and 2020 in our institution. Materials and Methods: A total of six patients in a single institution presented with CCAs who were treated with high-flow bypass surgery were included in this case-series. A single-case illustration was presented focusing on the details of surgical case management of CCA. The intraoperative middle cerebral artery (MCA) pressure monitoring during bypass surgery was also described. Results: All five female patients and one male patient who were diagnosed with cavernous carotid aneurysms were studied. The mean age was 68.8 years old (range: 24-84 years old) and the mean size of the aneurysm was 19.6mm (range: 9.7 – 30mm). There were successfully treated with high flow bypasses using radial artery graft without any neurological sequelae. Conclusion: The surgical treatments of cavernous carotid aneurysms should be limited to experienced neurosurgeons in view of significant risk of morbidity and mortality. Endovascular procedures may be the main stay of treatments. The success shown in this case series with parent artery occlusion and bypass surgery may provide an safe alternative to the endovascular treatment.

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“…There are also reported cases in the literature of ruptured cavernous carotid aneurysms as the cause of high-flow CCFs, [5][6][7] but many others have involved other pathology or iatrogenic trauma. One case series of spontaneous CCFs illustrated presentation with gradual onset EOM restriction, proptosis, or just injection of the conjunctiva that can occur in a variety of ages.…”

Section: Discussionmentioning

confidence: 99%

Sudden-onset Blindness from a Spontaneous Carotid-cavernous Fistula with Secondary Central Retinal Artery Occlusion and Posterior Ischemic Optic Neuropathy

Chhadva

Kanu

et al. 2018

Neuro-Ophthalmology

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Our case describes a patient diagnosed with a carotid-cavernous fistula (CCF) secondary to a spontaneously ruptured cavernous carotid aneurysm, presenting with sudden vision loss, and a concomitant central retinal artery occlusion as visualized by a cherry-red spot in the macula and posterior ischemic optic neuropathy. Computed tomography of the brain and orbits showed mild hydrocephalus, orbital fat haziness, and proptosis with concern for fluid in the basal cisterns. Cerebral angiography confirmed the suspected diagnosis of CCF. After angiography, a Magnetic resonance imaging of the brain demonstrated abnormal diffusion restriction in the posterior right optic nerve confirmed on the apparent diffusion coefficient map, consistent with ischemia of the optic nerve in this location. Two weeks after discharge, outpatient fundus photography showed resolution of her cherry-red spot, and optical coherence tomography showed thinning of the entire retinal nerve fiber layer as compared to the contralateral eye. In CCFs, congestive symptoms of proptosis, pain, and even central retinal vein occlusion findings are frequently described. However, our patient's no light perception vision and imaging findings suggest associated central retinal artery occlusion and ischemic optic neuropathy. These findings underscore the multitude of serious visual effects of high flow CCFs.

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4D flow preliminary investigation of a direct carotid cavernous fistula due to a ruptured intracavernous aneurysm

Cited by 6 publications

References 16 publications

4D-flow MRI assessment of blood flow before and after endovascular intervention in a patient with pulmonary hypertension due to isolated pulmonary artery involvement in large vessel vasculitis

4D-flow MRI assessment of blood flow before and after endovascular intervention in a patient with pulmonary hypertension due to isolated pulmonary artery involvement in large vessel vasculitis

High-flow bypass with radial artery graft for cavernous carotid aneurysms: A case series

Sudden-onset Blindness from a Spontaneous Carotid-cavernous Fistula with Secondary Central Retinal Artery Occlusion and Posterior Ischemic Optic Neuropathy

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