Traumatic carotid-cavernous fistula due to transection of the intracavernous carotid artery

Sbeih, Ibrahim; O'Laoire, Seán A.

doi:10.3171/jns.1984.60.5.1080

Cited by 12 publications

(7 citation statements)

References 37 publications

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“…The goal of treatment of TCCF using a detachable balloon is to occlude the fistula while maintaining the carotid flow by the balloon placed into the cavernous sinus (venous side)[ 23 , 24 ]. In our study, we compared therapeutic outcomes of patients with TCCFs treated with transarterial detachable balloon embolization from different centers as shown in Table 4 [ 12 - 14 , 19 - 22 , 25 - 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, an iodine-inflated balloon may progressively deflate, possibly causing a pseudoaneurysm. However, when oculomotor nerve palsy occurs, balloon deflation will usually result in complete recovery from the palsy[ 24 , 28 , 31 ]. Currently, detachable silicone balloons are not available, and detachable latex balloons have been used by inflating with iodinated contrast material.…”

Section: Discussionmentioning

confidence: 99%

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Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study

Iampreechakul,

Wangtanaphat,

Chuntaroj

et al. 2024

World J Radiol

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BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula (TCCF) is the elimination of fistula while maintaining patency of the parent artery. The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons, coils, liquid embolic agents, covered stents, or flow-diverter stent through arterial or venous approaches. Despite the withdrawal of detachable balloons from the market in the United States since 2004, transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries. However, the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up. AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF. METHODS Between January 2009 and December 2019, 79 patients diagnosed with TCCF were treated using detachable latex balloons (GOLDBAL) of four sizes. Pseudoaneurysm sizes were stratified into five grades for analysis. Initial and follow-up assessments involved computed tomography angiography at 1 month, 6 month, 1 year, and longer intervals for significant cases. Clinical follow-ups occurred semi-annually for 2 years, then annually. Factors analyzed included sex, age, fistula size and location, and balloon size. RESULTS In our cohort of 79 patients treated for TCCF, pseudoaneurysms formed in 67.1%, with classifications ranging from grade 0 to grade 3; no grade 4 or giant pseudoaneurysms were observed. The majority of pseudoaneurysms did not progress in size, and some regressed spontaneously. Calcifications developed in most large pseudoaneurysms over 5-10 years. Parent artery occlusion occurred in 7.6% and recurrent fistulas in 16.5%. The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes, with balloon SP and No. 6 significantly associated with its occurrence (P = 0.005 and P = 0.002, respectively), whereas sex, age, fistula size, location, and the number of balloons used were not significant predictors. CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common, primarily influenced by the size of the balloon used. Despite this, all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study

Iampreechakul,

Wangtanaphat,

Chuntaroj

et al. 2024

World J Radiol

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“…10) Different approaches and methods, such as neck clipping to retain the patency of the parent artery, have been used to close the fistula directly in patients with post-traumatic CCF. 4,8,11,12,14,15) On the other hand, proximal ligation or trapping of the parent artery may be useful 16,17) if direct surgical treatment of post-traumatic aneurysms is difficult because the fibrous wall is friable and the aneurysm neck is broad. 1,3,13) Simultaneously, ICA ligation may result in complications such as cerebral infarction, visual loss, and CCF recurrence, even if the Matas test is negative.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic Carotid-Cavernous Fistulae Treated by Internal Carotid Artery Trapping and High-Flow Bypass Using a Radial Artery Graft -Two Case Reports-

Mizunari

Murai

Kim

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Two patients presented with post-traumatic carotid-cavernous sinus fistulae (CCFs) that were successfully treated by high-flow bypass using a radial artery graft after initial unsuccessful attempts at obliteration by intravascular embolization. Case 1 was a 20-year-old man with a CCF detected by magnetic resonance imaging and angiography following an accident. Although the CCF appeared partially occluded by intravascular embolization, serial angiography revealed CCF recurrence. The CCF was trapped by placing a high-flow bypass. Case 2 was a 21-year-old man who presented with bilateral CCFs after sustaining face trauma. The bilateral CCFs were directly treated because of recurrence after balloon occlusion. At present, intravascular surgery is the first treatment choice, but placing a high-flow bypass with trapping of the CCF gained time to treat the CCF and may be useful for treating post-traumatic CCF that cannot be effectively eliminated by intravascular techniques.

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“…It may occur after either blunt or penetrating head trauma and represents an abnormal arteriovenous communication within the cavernous sinus, usually as a result of laceration or transection of the cavernous internal carotid artery (ICA) 2. The high flow within the fistula means that patients usually present with ocular or orbital venous congestive features and cephalic bruit 3 4.…”

Section: Introductionmentioning

confidence: 99%

Treatment of a traumatic carotid–cavernous fistula by the sole use of a flow diverting stent

Nadarajah

Power

Barry

et al. 2011

J NeuroIntervent Surg

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Traumatic carotid-cavernous fistula due to transection of the intracavernous carotid artery

Cited by 12 publications

References 37 publications

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study

Posttraumatic Carotid-Cavernous Fistulae Treated by Internal Carotid Artery Trapping and High-Flow Bypass Using a Radial Artery Graft -Two Case Reports-

Treatment of a traumatic carotid–cavernous fistula by the sole use of a flow diverting stent

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