Carotid‐cavernous fistula after endovascular intervention for chronic carotid artery total occlusion

Yeh, Chih‐Fan; Chen, Yin-Hsien; Lin, Mao‐Shin; Huang, Ching–Chang; Hung, Chi‐Sheng; Meng, Shih-Wei; Lee, Chih‐Kuo; Kao, Hsien‐Li

doi:10.1002/ccd.27392

Cited by 7 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To understand the indicators that might predict the risk of an iatrogenic CCF complication, some groups have studied the circumstances of these cases at their institutions. Yeh et al studied 138 surgical interventions to treat chronic carotid artery occlusion and observed that 8% of these resulted in a CCF [18]. The instances were self-limiting, and none resulted in stroke or death.…”

Section: Discussionmentioning

confidence: 99%

Delayed Iatrogenic Direct Carotid Cavernous Fistula Following Flow Diversion for Aneurysm With Spontaneous Healing: A Case Report

Voura,

Stulb,

Eller

et al. 2024

Cureus

View full text Add to dashboard Cite

An abnormal connection between the carotid artery and cavernous sinus is referred to as a carotid cavernous fistula (CCF). A direct CCF results when the connection occurs between the intracranial internal carotid artery (ICA) and the cavernous sinus. These events are typically the result of a head injury, but can also be iatrogenic, resulting from various intracranial procedures. Direct CCF occurrences rarely heal spontaneously due to the high flow rate across the fistula. In this report, we present an uncommon case involving a delayed iatrogenic direct CCF, which developed following the placement of a pipeline flow-diverting stent that was used to treat a cerebral aneurysm. Interestingly, this unusual iatrogenic direct CCF subsequently spontaneously resolved within a few months. To our knowledge, this is the only case of a delayed CCF occurring with the use of a flow-diverting sent, which then resolved on its own. This report recounts our experience with the case.

show abstract

Section: Discussionmentioning

confidence: 99%

Delayed Iatrogenic Direct Carotid Cavernous Fistula Following Flow Diversion for Aneurysm With Spontaneous Healing: A Case Report

Voura,

Stulb,

Eller

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…Several articles were published from the same institution in Taiwan, we selected one of their papers with the largest number (n=138) of patients for our study (24). Data from two additional papers from this institution were also used to identify perioperative (25,26). The final systematic review included 276 patients from 8 observational studies.…”

Section: Study Selectionmentioning

confidence: 99%

“…Endovascular recanalization of chronically occluded ICA was first reported by Terada et al in 2005 (6). Since then, multiple case reports (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) retrospective and prospective cohort studies (19)(20)(21)(22)(23)(24)(25)(26)(27)(28) have been published, most claiming benefit in patients who underwent successful endovascular or hybrid treatment, but no randomized controlled studies are available and society guidelines so far have failed to recommend endovascular therapy for symptomatic CTO of the ICA (29,30). The aim of this systematic review was to investigate patient selection, technical success, periprocedural complications, early and late outcome of endovascular treatment for symptomatic CTO of the ICA.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of endovascular treatment for chronic total occlusion of the internal carotid artery

Myrcha¹,

Gloviczki²

2021

Ann Transl Med

View full text Add to dashboard Cite

The management of patients with symptomatic chronic total occlusion (CTO) of the internal carotid artery (ICA) is controversial. The aim of this systematic review was to investigate patient selection, technical success, early and late outcome of endovascular treatment for CTO of the ICA. PubMed/Medline and EMBASE databases were searched until January 2, 2020 for studies on endovascular treatment for CTO of the ICA. A descriptive analysis of demographic, clinical and anatomic data, endovascular technique, perioperative and late outcomes was performed. A total of 1,222 articles were screened, 8 retrospective or prospective cohort studies were reviewed; 276 patients, 18.9% females, mean age: 64.3 years, underwent attempt at endovascular treatment of 278 lesions. 213 patients (77.2%) had neurological symptoms; the others had evidence of ipsilateral cerebral hypoperfusion. 238 lesions (91.2%) were treated >30 days after diagnosis of occlusion. Technical success was 66.9 %. Perioperative mortality was 1.64% (4/243), early stroke rate was 3.3%. Follow-up averaged 23.4 months (range: 0.25-84), late mortality was 1.89% (5/265), stroke rate was 3.4% (9/265). Stroke rate was similar after successful stenting (3.57%, 4/112) vs. failed stenting (3.61%, 2/61; P=1.00), stroke/death rates were also similar after successful stenting (5.36%, 6/112) than after failed stenting (3.28%, 2/61; P=0.71). Endovascular treatment of CTO of the ICA in eight cohort studies was safe and feasible with a technical success of 67% and a low rate of early and late neurological complications.Pooled data in this review failed to confirm the benefit of successful stenting on stroke and mortality, but some of the included studies suggest benefit and some also supported improvement in neurocognitive function after successful stenting. Prospective randomized trials to investigate the benefit of endovascular treatment in addition to best medical therapy for symptomatic CTO of the ICA are urgently needed.

show abstract

“…This was the only complication observed during surgery. CCF was not uncommon when performing endovascular maneuvers in patients with TO; its incidence was approximately 8% [5] . Much attention should be paid when exploring occluded segments, and if CCF occurs, the ICA should be sutured immediately.…”

mentioning

confidence: 99%

Hybrid surgery for symptomatic chronic near-total or total occlusion of the internal carotid artery

Wang

Han

Jia

et al. 2021

Chinese Medical Journal

View full text Add to dashboard Cite

Stroke is the second leading cause of death globally and accounts for an estimated 5.5 million deaths each year worldwide. [1] Revascularization of the carotid artery is one of the key procedures to reduce the incidence of stroke. Chronic total occlusion (TO) and near-total occlusion (NO) of the carotid artery are rare. Treatment for TO and NO is controversial with potential complications, including periprocedural stroke, intracranial hemorrhage, and carotid-cavernous fistula (CCF). [2] There have been attempts to implement carotid artery endarterectomy (CEA) and endovascular treatment, but the success rates were far from satisfactory. For patients with TO, the success rate of revascularization is around 40% and 60%, respectively, for CEA and endovascular technique. [3] For patients with NO, the morbidity and mortality rates are 3% and 9%, respectively.We attempted hybrid procedures to improve the revascularization rate. Issues with the suitability of these procedures were addressed by considering intraprocedural complications, 30-day morbidity and mortality, and longterm morbidity and mortality.

show abstract

Carotid‐cavernous fistula after endovascular intervention for chronic carotid artery total occlusion

Abstract: CCF may develop during chronic CAO endovascular recanalization attempts. It is usually self-limited and can be managed conservatively.

Cited by 7 publications

References 34 publications

Delayed Iatrogenic Direct Carotid Cavernous Fistula Following Flow Diversion for Aneurysm With Spontaneous Healing: A Case Report

Delayed Iatrogenic Direct Carotid Cavernous Fistula Following Flow Diversion for Aneurysm With Spontaneous Healing: A Case Report

A systematic review of endovascular treatment for chronic total occlusion of the internal carotid artery

Hybrid surgery for symptomatic chronic near-total or total occlusion of the internal carotid artery

Contact Info

Product

Resources

About