Transarterial Treatment of Traumatic Carotid Cavernous Sinus Fistula with Carotid Artery Dissection and Ruptured Pseudoaneurysm Using Flow Diverter and Detachable Coils

Abstract

Direct carotid cavernous sinus fistula is a common delayed complication of head trauma, particularly in patients with skull base fractures. When carotid cavernous sinus fistula occurs together with carotid artery dissection, it poses a big challenge regarding successful treatment. Endovascular treatment options include occlusion with detachable balloons, coils, and Pipeline flow diverters (Chestnut Medical Technologies, Menlo Park [CA], USA). Here we describe the successful management of a patient with dual pathology with traumatic carotid cavernous sinus fistula and internal carotid artery dissection with multiple pseudoaneurysms using flow diverters and detachable coils.

Treatment of carotid cavernous sinus fistulas with flow diverters. A case report and systematic review

“…who suffered from severe head trauma was clinically stable post-operatively and had neurological deficits at the last follow-up. 14 Nine patients received DAT as home therapy, one (#9, Iancu et al.) received clopidogrel alone, while no information was available for another (#11, Yoon et al.).…”

“…In 73,6% of the cases reported in the literature, transarterial and/or transvenous coiling, stent-grafts or Onyx were additionally used with FDD deployment. 13 , 14 , 17–21 , 24 , 26 , 27 Pradeep et al. reported two patients with post-traumatic high-flow CCFs.…”

“…described a case of a post-traumatic CCF which coexisted with a ruptured ICA pseudoaneurysm. 14 Both pseudoaneurysm and CCF were embolized using coils with subsequent application of a single FDD achieving complete occlusion and maintaining the patency of ICA despite the multiple lacerations. Oligvy et al.…”

Treatment of direct carotid-cavernous fistulas with flow diversion – does it work?

“…All of these flow diversion devices have been used to cure CCFs (Table 1). [17][18][19][20][21][22][23][24][25] While treatment with flow diversion necessitates at least three months of dual antiplatelet therapy and is associated with increased costs, it is a technically easy method of treatment and can prevent occlusion of the ICA when used in combination with coils. Combining flow diversion with non-matching patterns of the braided structures may increase their hemodynamic effect (e.g.…”