CTA-guided outflow-targeted embolization of direct carotid-cavernous fistula

Liao, Chih‐Hsiang; Chen, Wen-Hsien; Liao, Nien-Chen; Tsuei, Yuang-Seng

doi:10.3171/2019.1.focusvid.18447

Cited by 2 publications

(3 citation statements)

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“…Although entire occlusion of the SOV with coils was presented as illustrative cases in some studies, it has not been described in detail. 15,25 Liao et al 26 reported direct CCF treated with CT angiography-guided venous outflow-targeted coil embolization and described the advantages of outflow-targeted embolization as follows. First, embolization of the venous outflow first can keep the ICA visualized without being obscured by the embolic material.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the advantage that Liao et al 26 reported, another advantage exists concerning venous outflow-targeted coil embolization. When the engorged veins were occluded, the venous outflow pathway would be eliminated.…”

Section: Discussionmentioning

confidence: 99%

“…Another potential problem with SOV occlusion is that unintended flow redirection to the cortical vein may occur during the procedure, leading to serious complications such as venous hypertension and subsequent ICH. To avoid this potential problem, Liao et al 26 blocked intracranial reflux first by occluding the cortical vein before occluding the SOV. Similarly, we also occluded the cortical vein first before occluding the SOV, and no postprocedure ICH occurred.…”

Section: Discussionmentioning

confidence: 99%

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Venous outflow-targeted coil embolization of direct carotid-cavernous fistulas

et al. 2022

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Background Coil embolization is the mainstay treatment for carotid-cavernous fistulas (CCFs). However, few studies have reported entire occlusion of engorged veins to interrupt venous outflow. We report our experience with venous outflow-targeted coil embolization of direct CCFs. Methods We retrospectively reviewed all the patients diagnosed with direct CCFs treated with venous outflow-targeted coil embolization between November 2013 and February 2020. Venous outflow-targeted coil embolization of the CCFs was performed as follows. First, transarterial stent-assisted coil embolization of CCFs was performed. If the venous outflow to the engorged veins persisted after transarterial stent-assisted coil embolization, entire occlusion of the engorged veins and additional coil packing within the cavernous sinus were performed to interrupt the venous outflow. Results Ten patients had undergone venous outflow-targeted coil embolization, 6 women (60%) and 4 men (40%). Transfemoral cerebral angiography showed high-flow, direct CCFs in all the patients. Venous outflow occurred through the superior ophthalmic vein (SOV) in all the patients and was completely interrupted by the entire occlusion of the engorged veins with fibered coils. Three patients (30%) had undergone additional treatment in a supplementary manner because of recurrent symptoms (chemosis in 1 patient, faint tinnitus in 2 patients) in the early postprocedural period (1 to 4 weeks). All the symptoms were resolved on follow-up. No additional recurrence was found during follow-up (1–75 months). No peri-procedural complications were encountered. Conclusions Venous outflow-targeted coil embolization of CCFs would be a safe and effective treatment method.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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