Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature

Roy, Anil K.; Grossberg, Jonathan A; Osbun, Joshua W.; Skukalek, Susana L; Howard, Brian M.; Ahmad, Faiz U.; Tong, Frank; Dion, Jacques E.; Cawley, C. Michael

doi:10.1136/neurintsurg-2016-012586

Cited by 24 publications

(15 citation statements)

References 30 publications

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“…In fact, a study by Roy et al found a CCF rate of 11.4% in their series of 44 patients who underwent the PED procedure for CCA. 63 Lin et al presented 2 such cases of direct CCFs that formed as a result of delayed aneurysm rupture following PED treatment of CCA. 43 In cases of posttraumatic and spontaneous CCF, the PED may be a possible treatment option; however, there is a lack of larger studies to confirm the results of the few reported case reports and small series presented here.…”

Section: Carotid-cavernous Fistulasmentioning

confidence: 99%

Off-label uses of the Pipeline embolization device: a review of the literature

Patel

Chalouhi

Atallah

et al. 2017

Neurosurgical Focus

147

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The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments. However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications. Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas. The authors present a literature review of the safety and efficacy of the PED in these off-label uses.

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Section: Carotid-cavernous Fistulasmentioning

confidence: 99%

Off-label uses of the Pipeline embolization device: a review of the literature

Patel

Chalouhi

Atallah

et al. 2017

Neurosurgical Focus

147

View full text Add to dashboard Cite

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“…Including the present case, 14 cases of dCCF due to rupture of CCA previously treated with PED deployment have been reported (Table 1); parent artery occlusion (PAO) or TVE has been performed in preceding 13 cases. [4][5][6][7][8][9][10] PAO is not recommended in such cases because it can cause cerebral ischemia even if balloon occlusion test shows ischemic tolerance. 8) Oishi et al 9) pointed out that TVE may result in sinus packing of cavernous sinus in such cases, which disturb improvement of abducens nerve palsy.…”

Section: Discussionmentioning

confidence: 99%

Trans-Cell Technique through Mesh of Pipeline Embolization Device: A Case Report

Sonobe

Ezura

Kimura

et al. 2021

JNET

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We report a case of coil embolization using trans-cell technique through mesh of a pipeline embolization device (PED). Case Presentation: A 55-year-old female developed a left cavernous carotid aneurysm (CCA) with left abducens nerve palsy. The abducens nerve palsy improved gradually after PED deployment for the aneurysm. Sixty-nine days after the procedure, the patient suddenly presented with a severe headache, left abducens nerve palsy, left eyelid edema, and left pulsatile tinnitus. Digital subtraction angiography (DSA) revealed left direct carotid cavernous fistula (dCCF) due to rupture of the aneurysm, and the patient underwent endovascular treatment. A Marathon was guided into the left internal carotid artery, and a guidewire via the Marathon passed through the mesh of the PED. Then the Marathon advanced over the guidewire into the aneurysm through the mesh of the PED, with assistance of a distal access catheter and a balloon catheter. Transarterial intra-aneurysmal coil embolization using trans-cell technique was performed, and the shunt blood flow was diminished. After subsequent transvenous embolization (TVE), the shunt blood flow disappeared, and all neurological symptoms improved. When PED is deployed linearly at a diameter 0.5 mm smaller than the nominal diameter, the average strand spacing is calculated to be approximately 0.2 mm. Since PED is a braided stent, the spacing can be large. It is theoretically reasonable for Marathon with an outer diameter of 0.59 mm to pass through the mesh of the PED. Conclusion: In some cases, trans-cell technique through mesh of PED can be performed using a small diameter microcatheter. Keywords▶ pipeline embolization device, trans-cell technique through mesh of flow diverter, coil embolization through Marathon, cavernous carotid aneurysm, direct carotid cavernous fistula This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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“…To our knowledge, there are only four reports involving 10 patients with dCCF due to a delayed aneurysm rupture after flow diverter therapy ( Table 1 ). 13 , 18 – 20) The flow diverters used were three Silk flow diverter stents (Balt, Extrusion, Montmorency, France) and seven PEDs. Seven patients were treated with PAO and the remaining 3 patients with transvenous coil embolization of the affected CS.…”

Section: Discussionmentioning

confidence: 99%

Transvenous Aneurysm Sac and Rupture Point Coil Embolization of Direct Carotid Cavernous Fistula after Pipeline Embolization

Oishi

Teranishi

Yatomi

et al. 2018

NMC Case Report Journal

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A delayed aneurysm rupture after flow diverter therapy is a rare but serious complication. Due to the anatomical specificity, a delayed rupture of a carotid cavernous aneurysm may cause a direct carotid cavernous fistula (dCCF). We present a novel therapeutic approach for treatment of dCCF after flow diverter therapy using the Pipeline embolization device (PED). An 86-year-old woman suffered from dCCF after PED embolization. A microcatheter was advanced through the transvenous approach into the cavernous sinus (CS) and further inserted into the aneurysm sac via the rupture point. Coil embolization of both the aneurysm sac and a small part of the CS adjacent to the fistulous site could achieve not only the immediate aneurysm occlusion but also the rupture point obliteration with a small amount of coil mass in the CS.

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Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature

Cited by 24 publications

References 30 publications

Off-label uses of the Pipeline embolization device: a review of the literature

Off-label uses of the Pipeline embolization device: a review of the literature

Trans-Cell Technique through Mesh of Pipeline Embolization Device: A Case Report

Transvenous Aneurysm Sac and Rupture Point Coil Embolization of Direct Carotid Cavernous Fistula after Pipeline Embolization

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