Treatment of Post-Traumatic Carotid-Cavernous Fistulas with the Willis Covered Stent

Yl, Wang; Ma, Jing; Ding, Peng-Xu; Yd, Li; Xw, Han; Wu, Guomin

doi:10.1177/159101991201800208

Cited by 15 publications

(13 citation statements)

References 16 publications

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“…Covered stents can be used in some conditions in which detachable balloons and coils cannot be utilized. The reported success rate to date of detachable balloon, flow diverter and covered stent for occlusion of TCCF as primary treatment modality was 55–98% [ 8 , 14 , 20 ], 71% [ 42 ], and 75–100% [ 12 , 26 , 41 ], respectively and our results were similar with previous reports. Moreover, it has advantages in the concept of one-step and time-saving treatment in emergency situations.…”

Section: Discussionsupporting

confidence: 90%

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First line Treatment of Traumatic Carotid Cavernous Fistulas Using Covered Stents at Level 1 Regional Trauma Center

Jeong

Lee

Choi

et al. 2021

J Korean Neurosurg Soc

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Objective : The widely accepted treatment option of a traumatic carotid cavernous fistula (TCCF) has been detachable balloon or coils based fistula occlusion. Recently, covered stent implantation has been proving an excellent results. The purpose of this study is to investigate our experiences with first line choice of covered stent implantation for TCCF at level 1 regional trauma center. Methods : From November 2004 to February 2020, 19 covered stents were used for treatment of 19 TCCF patients. Among them, 15 cases were first line treatment using covered stents. Clinical and angiographic data were retrospectively reviewed. Results : Procedures were technically successful in all 15 cases (100%). Immediate angiographic results after procedure were total occlusion in 12 patients (80%). All patients except two expired patients had image follow-up (mean 15 months). Recurred symptomatic three patients underwent additional treatments and achieved complete occlusion. Mean clinical follow-up duration was 32 months and results were modified Rankin Scale 1-2 in five, 3-4 in five, and 5 in three patients. Conclusion :The covered stent could be considered as fist line treatment option for treating TCCF patients especially in unstable vital sign. Larger samples and expanded follow-up are required to further develop their specifications and indications.

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Section: Discussionsupporting

confidence: 90%

“…A recent study used a covered stent in DCCF and reported the outcomes [ 2 , 5 , 12 , 16 , 25 , 26 , 38 , 40 , 41 ]. Covered stents can be used in some conditions in which detachable balloons and coils cannot be utilized.…”

Section: Discussionmentioning

confidence: 99%

First line Treatment of Traumatic Carotid Cavernous Fistulas Using Covered Stents at Level 1 Regional Trauma Center

Jeong

Lee

Choi

et al. 2021

J Korean Neurosurg Soc

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“…Recently, a new kind of covered stent specifically designed for intracranial use has reduced on the problem. The stent is reported to be more flexible and to achieve good preliminary results in DCCF treatment 18) . Further progress can be anticipated as technology of the covered stents and their delivery systems continue to evolve.…”

Section: Discussionmentioning

confidence: 99%

Covered Stents for the Endovascular Treatment of a Direct Carotid Cavernous Fistula : Single Center Experiences with 10 Cases

Cho

Kim

et al. 2015

J Korean Neurosurg Soc

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ObjectiveCovered stent has been recently reported as an effective alternative treatment for direct carotid cavernous fistulas (DCCFs). The purpose of this study is to describe our experiences with the treatment of DCCF with covered stents and to evaluate whether a covered stent has a potential to be used as the first choice in selected cases.MethodsFrom February 2009 through July 2013, 10 patients underwent covered stent placement for a DCCF occlusion. Clinical and angiographic data were retrospectively reviewed.ResultsCovered stent placement was performed for five patients primarily as the first choice and in the other five as an alternative option. Access and deployment of a covered stent was successful in all patients (100%) and total occlusion of the fistula was achieved in nine (90%). Complete occlusion immediately after the procedure was obtained in five patients (50%). Endoleak persisted in five patients and the fistulae were found to be completely occluded by one month control angiography in four. The other patient underwent additional coil embolization by a transvenous approach. Balloon inflation-related arterial dissection during the procedure was noted in two cases; healing was noted at follow-up angiography. One patient suffered an asymptomatic internal carotid artery occlusion noted seven months post-treatment.ConclusionAlthough endoleak is currently a common roadblock, our experience demonstrates that a covered stent has the potential to be used as the first choice in DCCF; this potential is likely to increase as experience with this device accumulates and the materials continue to improve.

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“…However, it has not been widely applied, because it is sometimes difficult to position it in place. [ 17 – 19 ] Gel or coil embolization is the most effective treatment for patients with type V (Fig. 4 B).…”

Section: Discussionmentioning

confidence: 99%

Clinical classification and individualized design for the treatment of basicranial artery injuries

Yang

Li²,

Xiang³

et al. 2019

Medicine

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This study aims to explore the principles of clinical classification and individualized treatment of basicranial artery injuries based on its anatomical correlation.The data of 172 patients with various types of basicranial artery injuries were retrospectively analyzed. Among these patients, 128 patients were male and 44 patients were female, and the average age of these patients was 28.3 years old. All patients underwent computed tomography, some patients underwent computed tomography angiography or magnetic resonance angiography, and all the diagnoses were confirmed by digital subtraction angiography (DSA). According to anatomical correlation, the injuries were classified into 5 types: vascular wall injury (type I), intradural injury (type II), epidural injury (type III), sinus injury (type IV), and skull base bone injury (type V). Individualized treatment was adopted based on the different types and characteristics of injuries.The percentages of basicranial artery injuries were as follows: type I, 4.6%; type II, 5.8%; type III, 3.5%; type IV, 77.9%; and type V, 8.1%. All 172 patients underwent DSA to demonstrate the classification. The lesion elimination rate revealed by DSA was 99.4% immediately after the operation, 98.3% at 1 week after the operation, and 98.8% at 3 months after the operation. The follow-up after 6 months revealed that the percentage of patients in whom clinical symptoms or signs completely disappeared was 97.7%, the percentage of patients with limited eye movement or visual impairment was 1.2%, and the percentage of patients with mild limb dysfunction was 0.6%.Basicranial artery injuries can be classified into 5 types. Individualized design of embolization therapy based on different characteristics might be applicable for basicranial artery injuries treatment.

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Treatment of Post-Traumatic Carotid-Cavernous Fistulas with the Willis Covered Stent

Cited by 15 publications

References 16 publications

First line Treatment of Traumatic Carotid Cavernous Fistulas Using Covered Stents at Level 1 Regional Trauma Center

First line Treatment of Traumatic Carotid Cavernous Fistulas Using Covered Stents at Level 1 Regional Trauma Center

Covered Stents for the Endovascular Treatment of a Direct Carotid Cavernous Fistula : Single Center Experiences with 10 Cases

Clinical classification and individualized design for the treatment of basicranial artery injuries

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