Endovascular treatment of carotid-cavernous fistulae: Long-term efficacy and prognostic factors

Stephan, S.; Blanc, Raphaël; Zmuda, Mathieu; Vignal, Catherine; Barral, Matthias; Pistocchi, Silvia; Piotin, Michel; Galatoire, O.

doi:10.1016/j.jfo.2015.04.021

Cited by 7 publications

(12 citation statements)

References 20 publications

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“…iCCFs are shunts between meningeal branches from the ICA and/or the ECA and the CS, which account for 83% of all CCFs. 2 iCCFs are the second most common site of intracranial dural arteriovenous fistulas (dAVFs), following the transverse/sigmoid sinus junction. 1…”

Section: Discussionmentioning

confidence: 99%

“…6 17 Overall, the safest and most effective transvenous approach for iCCFs is the inferior petrosal sinus; however, the route must be individualized. 2 4 Thomas type 1 and 2 CCFs should be treated through a posterior transvenous approach, type 3 CCFs through an anterior transvenous approach, and type 5 CCFs through a transarterial approach. Since a generalized approach recommendation cannot be made for type 4 lesions (due to the presence of CVR), these fistulas may be treated through open surgery or transvenous/transarterial approaches.…”

Section: Discussionmentioning

confidence: 99%

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Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical Note

Abaunza-Camacho

Vergara-García

Madriñán-Navia

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background Indirect carotid–cavernous fistulas (iCCFs) are shunts between meningeal branches of the internal carotid and/or the external carotid arteries and the cavernous sinus. They account for 83% of all carotid–cavernous fistulas (CCFs). Symptomatic iCCFs and those with increased risk of hemorrhage should be treated. Transvenous endovascular treatment is the preferred treatment modality. However, in complex cases, a combination of transarterial and transvenous approaches (multimodal treatment) is required. Methods A middle-aged woman presented with signs of increased intraocular pressure, blurry vision, diplopia, left proptosis, chemosis, conjunctival injection, ptosis, and cranial nerve VI palsy. Imaging confirmed the presence of a Barrow type D and Thomas type 4 iCCF with cortical venous reflux (CVR). Results The patient underwent transarterial and transvenous onyx embolization of the shunt, achieving a complete obliteration of the fistula. No complications occurred and the patient had a satisfactory postprocedural evolution. Conclusion Multimodal onyx embolization is an effective option for the treatment of a complex symptomatic iCCF. If CVR is identified, these lesions should be promptly treated to prevent hemorrhage secondary to rupture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical Note

Abaunza-Camacho

Vergara-García

Madriñán-Navia

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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“…In cases of direct CCF, embolization via arterial route is preferred with the preservation of ICA patency wherever possible. 2 3 8 9 13 Detachable silicone balloons were used frequently as an inexpensive embolizing agent for direct CCF with excellent success rates in various series. 2 7 8 9 13 In our study, 12 (26.6%) cases of direct CCF were treated with detachable balloons only ( Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Also, the rate of reintervention/recurrence is more in balloon embolization as the packing of the fistula defect is not always optimum. 7 13 14 Too large defect size, very tortuous and unfavorable anatomy, placement of multiple balloons, and incomplete embolization in the first session were considered important risk factors for failed treatment/recurrence. 2 7 12 13 We needed more than one treatment session in 8 out of 21 cases (38.09%) where detachable balloons were used as primary embolizing material.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Direct Carotid–Cavernous Fistula: Evolution of Cost Effective Sandwich Technique

Prasad

Singh

Boruah

et al. 2020

JNRP

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Objective There is a direct fistulous connection between the cavernous segment of the internal carotid artery and cavernous sinus in cases of direct carotid–cavernous fistula (CCF). Endovascular embolization is the mainstay of management in this condition. This study is about the evolution of endovascular treatment methods and the development of a cost-effective technique for embolization of direct CCF at a tertiary care center. Materials and Methods A retrospective analysis was performed of all the cases of direct type CCF embolized by endovascular techniques in our department from 2008 to 2018.Clinical follow-up of these patients was done at 1 week, 3 months, and 6 months. Results A total of 45 patients with 40 having a prior history of head trauma were included in this study. All cases were treated with a transarterial route except one which was treated with the transvenous approach. Detachable balloons were used in 12 (26.67%) patients, only detachable coils in 14 cases (31.11%), both detachable balloons and coils in 9 cases (20%), and both detachable and push coils, that is, sandwich technique in 8 cases (17.78%). Parent arterial occlusion was performed in 10 patients (22.22%). There was complete resolution of chemosis and bruit in all the patients. Conclusions Endovascular treatment is the mainstay of management in direct CCF. Using more fibered thrombogenic coils in a sandwich manner decreases the cost of the treatment significantly.

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“…However, CAO recanalization is still controversial and technically challenging, with potential complications of peri‐procedural stroke, intracranial hemorrhage (ICH) or subarachnoid hemorrhage (SAH), pseudo‐aneurysm formation, and carotid‐cavernous fistula (CCF) . Established symptomatic CCF, such as diplopia, ptosis and loss of visual acuity, associated with head and facial trauma or surgery usually requires endovascular therapy for treatment. However, the manifestation and management of iatrogenic CCF during CAO endovascular recanalization have not been well described in the literature.…”

Section: Introductionmentioning

confidence: 99%

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

Yeh

Chen

Lin

et al. 2017

Cathet Cardio Intervent

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Endovascular treatment of carotid-cavernous fistulae: Long-term efficacy and prognostic factors

Cited by 7 publications

References 20 publications

Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical Note

Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical Note

Endovascular Management of Direct Carotid–Cavernous Fistula: Evolution of Cost Effective Sandwich Technique

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

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