Combined transarterial N-butyl cyanoacrylate and coil embolization of direct carotid–cavernous fistulas

IntroductionInjuries to the internal carotid artery close to the cavernous sinus may result in a fistulous connection between the artery and the venous sinus. Symptoms include pulsatile tinnitus, intracranial bruit, ophthalmological symptoms, and risk of intracerebral hematoma in cases of cortical venous reflux. Previous treatment strategies have included detachable latex balloons, coils, covered stents, or combinations thereof. Today, detachable latex balloons are phased out or withdrawn from several markets. Acrylic glue is a proven stable material used for embolization of arteriovenous shunts. It is a precise, fast, and cost-effective method of endovascular embolization, and it does not cause artifacts on MRI or MRA.MethodsWe treated nine patients suffering from direct fistulas with acrylic glue without any permanent neurological adverse events.ResultsFour patients were treated with glue embolization of the fistula without occlusion of the parent artery. Five patients with long-lasting symptomatology, large tears in the ICA, and with full collateral cerebral circulation were treated with glue embolization of the fistula and sacrifice of the ICA antero- and retrograde via the ICA and the posterior communicating artery.ConclusionWe suggest acrylic glue to be added to the panel of embolic materials used to treat CCFs.

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“…This approach may facilitate glue injection, thanks to the reduction of the flow obtained with coils [6]. …”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of carotico-cavernous fistulas with acrylic glue: a series of nine cases

2016

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“…The use of stents (both covered and porous), platinum coils, HydroCoils, and liquid embolic agents for CCF treatment has been reported in case series (52,65,148). Although transvenous routes have been the most successful, transarterial approaches have also been successful, depending on the anatomy of the CCF and the vascular access route (93,146).…”

Section: Cerebral Endovascular Neurosurgerymentioning

confidence: 99%

Cerebral Endovascular Neurosurgery

Hopkins

Ecker

2008

Neurosurgery

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Cerebral endovascular neurosurgery has evolved rapidly in the past decade through advances in tools and techniques and as a result of the thrust toward evidence-based medicine. More patients with diseases traditionally treated via microsurgical approaches can now be treated with techniques that focus on endoluminal reconstruction. With the introduction of intracranial clot retrievers and appropriately sized stents, stroke care is being slowly revolutionized for those patients with salvageable brain tissue at the time of admission to the hospital. In this article, the recent history, current state, and possible future of cerebral endovascular neurosurgery are reviewed for the following diseases: stroke, intracranial atherosclerotic disease, brachiocephalic occlusive disease, cerebral aneurysms, central nervous system vascular malformations, and brain tumors. New concepts and applications for endovascular treatment of epilepsy and multiple sclerosis are mentioned. The potential for nanotechnology in this field and the future endovascular suite are envisioned.

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