Endovascular treatment of carotid–cavernous sinus fistulas: ophthalmic and visual outcomes

Holland, Lee; Ranzcr, Ken Mitchell; Harrison, J. D.; Brauchli, Damien; Wong, Yun; Sullivan, Tim

doi:10.1080/01676830.2018.1544261

Cited by 17 publications

(15 citation statements)

References 38 publications

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“…It might be related to fast speed of injecting glue [ 15 ]. If blood flow velocity of the fistula is fast, injecting fast can easily cause Onyx glue to reflux to internal carotid, which will lead to an ischemia stroke [ 16 ]. Loose implantation of some coils in cavernous sinus slows down the blood flow velocity of the fistula.…”

Section: Discussionmentioning

confidence: 99%

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

Zheng

2021

BioMed Research International

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The objective of this study was to observe the curative effect of combined arteriovenous approach embolization on complex carotid-cavernous fistulas. The clinical data of 13 patients with complex carotid-cavernous fistulas treated with combined arteriovenous approach embolization in our department between January 2017 and January 2020 were analyzed retrospectively. All 13 patients received the combined arteriovenous approach embolization with coil combined with Onyx glue. The intraoperative angiography immediately showed that the fistula could be completely blocked, and the carotid artery was/got unobstructed. The patients had no clinical symptoms recurring during a follow-up period of 3-18 months, on average 9.1 ± 6.3 months. A combined arteriovenous approach embolization on complex carotid-cavernous fistulas is safe and effective since it can improve the occlusion rate and reduce the relapse rate.

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Section: Discussionmentioning

confidence: 99%

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

Zheng

2021

BioMed Research International

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“…3) In any of the procedures, a study reported a complication, diplopia (1%-30%), 1) and another study reported that diplopia did not decrease (50%). 7) Ghannam et al reported the development of delayed cranial nerve symptoms after TAE, and stated that etiological factors included chronic ischemia related to a coil mass, inflammation related to thrombus formation, and the loss of a compensatory function. 8) At our institution, delayed cranial nerve symptoms also developed in one patient in whom TAE alone was performed (Case 3).…”

Section: Discussionmentioning

confidence: 99%

Transarterial and Transvenous Coil Embolization of Direct Carotid-cavernous Fistulas

Fukawa

Nakagawa

Tsuji

et al. 2022

JNET

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Objective: Transvenous embolization (TVE) is typically used in combination with the residual shunt of transarterial embolization (TAE) for the treatment of direct carotid-cavernous fistulas (direct CCFs). This report is about our additional embolization method using combination therapy.Case presentation: Five consecutive cases of direct CCF were presented; two were caused by aneurysms and three by head injuries. The treatment for each was started with TAE, with the addition of TVE if a shunt remained. At the time of TVE, a microcatheter positioned in the internal carotid artery passing from the cavernous sinus through the aneurysm neck or fistula was pulled back (pull-back method). It was then placed in the coil mass with TAE, and additional coils were filled. In two cases, the shunt disappeared by using only TAE, whereas it disappeared after being additionally embolized by the pull-back method in the remaining cases. All patients recovered with no postoperative complications. Conclusion:The TAE and TVE combination therapy with the pull-back method could efficiently embolize the residual shunt after TAE.Keywords▶ transfistula catheterization, detachable coils, fistula involved compartment, cavernous sinus packing

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“… 2 3 4 7 8 The predominant venous drainage pathway determines how the patient will present clinically. 1 4 9 10 The venous reflux may occur into superior/inferior ophthalmic veins (resulting in the development of proptosis, chemosis, orbital bruit, eye congestion, and exposure keratitis), cortical veins (resulting in headache and venous infarcts), pterygoid venous plexus and petrosal sinuses (resulting in headache and tinnitus), or medially to opposite cavernous sinus through intercommunicating veins (resulting in bilateral ocular signs and symptoms).…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…During the procedure, repeated inflation–deflation of the balloon within cavernous sinus should be avoided as this increases the chances of thromboembolic cerebrovascular events. 7 8 9 Also the patient needs to keep his neck in certain partially extended posture for a day or two and avoid violent movement or straining activities like vigorous coughing, sneezing, or repeated yawning as the balloon may displace/dislodge from the region of cavernous sinus defect. Sometimes in acute cases, the balloon may get perforated by fractured bony fragment in the region of the cavernous sinus.…”

Section: Discussionmentioning

confidence: 99%

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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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Endovascular treatment of carotid–cavernous sinus fistulas: ophthalmic and visual outcomes

Cited by 17 publications

References 38 publications

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

Transarterial and Transvenous Coil Embolization of Direct Carotid-cavernous Fistulas

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

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