Iatrogenic Carotid-Cavernous Fistula after Stent Assisted Coil Embolization of Posterior Communicating Artery Aneurysm

Park, Hye-Ran; Yoon, Seok-Mann; Shim, Jai-Joon; Bae, Hack Gun; Yun, Il Gyu

doi:10.7461/jcen.2015.17.1.43

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…On the other hand, the clinical course of iatrogenic CCF following endovascular intervention is often benign, even though being type A with high‐flow shunting . Park HR et al reported a case of iatrogenic CCF, created by the proximal tip of Solitaire stent after stent assisted coil embolization of posterior communicating artery aneurysm . The high‐flow shunt was still present 7 days post procedure, but remained asymptomatic 3 months later under conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…None of the CCF resulted in clinical sequela, and all healed spontaneously at follow‐up angiography. Arterial wall injury in endovascular intervention is caused by vessel wall disruption from intima towards adventitia, unlike traumatic or iatrogenic CCF during trans‐sphenoidal surgery, in which the disruption is from adventitia towards intima and usually more extensive . As the CCF was detected before complete revascularization of the proximal carotid artery, the low in‐flow pressure limited the fistula flow and pressure.…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence of iatrogenic CCF had been described during endovascular interventions involving the anterior intracranial vasculature, such as coil embolization for aneurysm, intra-arterial injection, and angioplasty for vasospasm [15,16]. However, CCF as a procedural consequence of CAO recanalization has never been systematically trans-sphenoidal surgery, in which the disruption is from adventitia towards intima and usually more extensive [27]. As the CCF was detected before complete revascularization of the proximal carotid artery, the low in-flow pressure limited the fistula flow and pressure.…”

Section: Discussionmentioning

confidence: 99%

“…However, these interventions carry their own risks of complications, including cerebral infarction, decreased visual acuity, diabetes insipidus, ophthalmoplegia, or ICH[25,26].On the other hand, the clinical course of iatrogenic CCF following endovascular intervention is often benign, even though being type A with high-flow shunting[18]. Park HR et al reported a case of iatrogenic CCF, created by the proximal tip of Solitaire stent after stent assisted coil embolization of posterior communicating artery aneurysm[27]. The high-flow shunt was still present 7 days post procedure, but remained asymptomatic 3 months later under conservative treatment.In the present series, the cause of CCF was injury by either wire or balloon angioplasty.…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Only 1 case of CCF during treatment with the Willis covered stent has been reported. 28 CCF was most likely due to arterial vascular lesion(s) caused by guiding catheter, guidewire, or balloon inflation during stent delivery into the tortuous PA.. 28,29 The skills of the doctors performing the procedure are important in minimizing vascular injuries associated with stent delivery.…”

Section: Other Complicationsmentioning

confidence: 99%

Endovascular treatment of distal internal carotid artery aneurysms and vertebral artery dissecting aneurysms with the Willis covered stent: A single-center, retrospective study

Zhang

et al. 2022

Interv Neuroradiol

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Background More data is needed on the short- and medium-term efficacy and safety of the Willis covered stent in treating distal internal carotid artery (DICA) aneurysms and vertebral artery dissecting aneurysms (VADAs). Methods Records of all 42 patients with DICA aneurysms or VADAs treated with the Willis covered stents at our institute between July 2014 and January 2019 were retrospectively examined. The patients’ demographic information, symptoms, diagnosis, treatment procedure, immediate and follow-up clinical and angiographic outcomes were extracted. Results 46 Willis covered stents were successfully implanted in all of the 42 patients (total 43 aneurysms). Immediate complete aneurysm occlusion was achieved in 37 patients (38 aneurysms) (88.4%), and endoleak occurred to 5 patients (5 aneurysms) (11.6%). 2 patients died post-operatively from procedure-related complications, another one died from reasons unrelated to the procedure. Among the remaining 39 patients, non-lethal complications occurred in 4 patients including ptosis and diplopia of the right eye, intra-operative hemorrhage and carotid cavernous fistulas (CCF). Angiographic and clinical follow-ups (means ± standard deviation: 8.8 ± 5.3 months) were done for 32 patients (33 aneurysms). Complete occlusion was maintained in all of the 33 aneurysms. 2 of the 32 patients had significant though asymptomatic parent artery (PA) occlusion. No ischemic or hemorrhagic event occurred during the follow-up period. The modified Rankin Scale (mRS) score was 0 in 31 patients and 1 in the remaining 1 patient. Conclusions The Willis covered stent could be a safe and effective treatment for complex DICA aneurysms with excellent durability. In addition, the Willis covered stent treated all of the 3 cases of VADAs in the study with complete success without any complications, however, as the number of the VADA cases was small, more cases are needed to further confirm the efficacy and safety of the Willis covered stent in treating VADAs.

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Direct carotid cavernous sinus fistulae: vessel reconstruction using flow-diverting implants

et al. 2016

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PurposeRetrospective evaluation of our experience with the use of flow diverters (FD) for the endovascular treatment of direct carotid-cavernous sinus fistulae (diCCF).MethodsBetween 2011 and 2015, 14 consecutive patients with 14 diCCF were treated with FD alone or in combination with other implants in a single institution.ResultsA total of 21 sessions were performed in 14 patients. FD placement was technically successful in all cases without an adverse event. Patients were treated with FD alone (n = 5), FD and covered stents (n = 2), FD and coils (n = 7). A total of 59 FD (24 Pipeline Embolization Device, Medtronic; 35 p64 Flow Modulation Device, phenox), 291 coils, and 3 stent grafts were used. Three of 14 diCCF were completely occluded after the 1st session, a minor residual shunt was found in 7/14, and in the remaining 4/14 patients, the shunt volume was reduced significantly. The mean follow-up period encompassed 20 months. Additional treatment included transvenous coil occlusion (n = 3) and/or further FD deployment (n = 5). An asymptomatic internal carotid artery (ICA) occlusion was encountered in 2 patients, related to an interruption of antiaggregation. At the last follow-up, 10/14 patients were free from ocular symptoms (71 %), 2 had residual exophthalmos, and no patient had clinical deterioration.ConclusionThe usage of FD for the treatment of diCCF is straightforward. Injury of the cranial nerves can be avoided. In most cases, ocular symptoms improve. Several FD layers and/or an adjunctive venous coil occlusion are required. Complete occlusion of a diCCF may take weeks or months and long-term antiaggregation is required. In the future, a flexible stent graft might be a better solution.

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Iatrogenic Carotid-Cavernous Fistula after Stent Assisted Coil Embolization of Posterior Communicating Artery Aneurysm

Cited by 7 publications

References 27 publications

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

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

Endovascular treatment of distal internal carotid artery aneurysms and vertebral artery dissecting aneurysms with the Willis covered stent: A single-center, retrospective study

Direct carotid cavernous sinus fistulae: vessel reconstruction using flow-diverting implants

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