Treatment of Traumatic Carotid-Cavernous Fistula

Wu, Zhongxue; Zhang, Y.; Wang, C.; Yang, Xinjian; Li, Y.

doi:10.1177/159101990000600402

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…Over the years, worldwide studies have showed varying degrees of success at achieving the ideal outcome. Internal carotid artery preservation rate in reviewed studies ranged between 40% and 84% 13,14 and CCF occlusion between 86% and 100%. 13,15 To date, scant local data exist to our knowledge.…”

Section: Discussionmentioning

confidence: 99%

Imaging findings and outcomes in patients with carotid cavernous fistula at Inkosi Albert Luthuli Central Hospital in Durban

Timol

Amod²,

Harrichandparsad

et al. 2018

S. Afr. j. radiol.

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BackgroundCarotid cavernous fistulas (CCFs) are relatively uncommon and are difficult to diagnose clinically. Radiological imaging plays a significant role in making the diagnosis with recent advances improving the ability of radiologists to diagnose the condition. Despite these developments, digital subtracted angiography (DSA) remains the gold standard in diagnosing CCFs and simultaneously provides the opportunity for intervention.ObjectivesTo determine the imaging findings of patients presenting to Inkosi Albert Luthuli Central Hospital (IALCH) with a CCF and to assess the outcome of endovascular intervention.MethodWe reviewed the electronic records and archived imaging data of consecutive patients diagnosed with CCF between January 2003 and May 2016 at IALCH, in particular, the imaging findings, intervention and subsequent outcomes.ResultsComputed tomography (CT) was the most utilised imaging modality prior to patients undergoing DSA. A dilated superior ophthalmic vein (96%) was the most prevalent imaging finding on axial imaging. At DSA, all except two patients had high-flow fistulas. The fistulas predominantly drained anteriorly (69.44%) and a cavernous internal carotid artery aneurysm was identified in eight patients. Occlusion of the fistula was attained in all patients that were compliant with follow-up and underwent intervention (n = 36, 100%), but parent artery sacrifice was required in 10 cases (27.78%).ConclusionA wide range of imaging modalities can be used in the workup of a CCF. CT is currently the most accessible modality in our setting, with limited access to magnetic resonance imaging. On axial imaging, a dilated superior ophthalmic vein is the commonest finding. Classification of a fistula according to flow dynamics and noting the presence of aneurysms or pseudoaneurysms was found to be more practical in comparison to the traditional Barrow’s classification. Management outcomes at our institution compare well with available local and international data.

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Section: Discussionmentioning

confidence: 99%

Imaging findings and outcomes in patients with carotid cavernous fistula at Inkosi Albert Luthuli Central Hospital in Durban

Timol

Amod²,

Harrichandparsad

et al. 2018

S. Afr. j. radiol.

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“…The two common treatment options for TCVI are surgery and endovascular coil embolization. Endovascular intervention is feasible in cases of AVF, 9,25,30 and treatments of pseudoaneurysm have been discussed elsewhere. 14,25,29 Based on expert opinion, the type of TCVI and anatomical considerations, such as size, location, and morphological features, determine which treatment is most appropriate for the individual patient.…”

Section: Discussionmentioning

confidence: 99%

Traumatic cerebrovascular injury: clinical characteristics and illustrative cases

Tunthanathip¹,

Phuenpathom²,

Saeheng³

et al. 2019

Neurosurgical Focus

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OBJECTIVETraumatic cerebrovascular injury (TCVI) is a rare and serious complication of traumatic brain injury (TBI). Various forms of TCVIs have been reported, including occlusions, arteriovenous fistulas, pseudoaneurysms, and transections. They can present at a variety of intervals after TBI and may manifest as sudden episodes, progressive symptoms, and even delayed fatal events. The purpose of this study was to analyze cases of TCVI identified at a single institution and further explore types and characteristics of these complications of TBI in order to improve recognition and treatment of these injuries.METHODSThe authors performed a retrospective review of cases of TCVI identified at their institution between 2013 and 2016. A total of 5178 patients presented with TBI during this time period, and 42 of these patients qualified for a diagnosis of TCVI and had adequate medical and imaging records for analysis. Data from their cases were analyzed, and 3 illustrative cases are presented in detail.RESULTSThe most common type of TCVI was arteriovenous fistula (86.4%), followed by pseudoaneurysm (11.9%), occlusion (2.4%), and transection (2.4%). The mortality rate of patients with TCVI was 7.1%.CONCLUSIONSThe authors describe the clinical characteristics of patients with TCVI and provide data from a series of 42 cases. It is important to recognize TCVI in order to facilitate early diagnosis and treatment.

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“…Recurrence after ICA occlusion/PAO has been seen due to reverse filling of thefistula through the distal ICA. 5 Studies have shown recurrence Recurrence of CCF after Treatment Kumar et al…”

Section: Discussionmentioning

confidence: 99%

“…1,3 However, there are only very few instances of recurrence of CCF following endovascular PAO. 4,5 We present two cases of CCF with recurrence following complete exclusion by PAO. The factors predisposing to this unusual occurrence are discussed.…”

Section: Introductionmentioning

confidence: 99%

Rare Recurrence of Traumatic Carotid Cavernous Fistula after Parent Artery Occlusion—Report of Two Cases and Review of Literature

Kumar

Malik

Rajan

et al. 2018

J Clin Interv Radiol ISVIR

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The authors present two cases of recurrence of traumatic carotid cavernous fistula (CCF) following complete exclusion by parent artery occlusion (PAO). In both cases, the fistula recurred through the development of indirect CCF and reconstitution of the occluded artery through the development of vasa vasorum or simple recanalization of the parent artery. The cavernous venous sac was patent in both cases. The patent cavernous sac along with the inflammatory or angiogenetic factors might have induced dural neovascularization leading to the development of indirect CCF. These factors along with ischemia of the arterial wall secondary to the steal phenomenon due to persistent shunt flow would have triggered the development of vasa vasorum. Thus the cavernous sac embolization may have to be considered in addition to PAO when PAO is planned as a therapeutic option for direct CCF.

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Treatment of Traumatic Carotid-Cavernous Fistula

Cited by 14 publications

References 16 publications

Imaging findings and outcomes in patients with carotid cavernous fistula at Inkosi Albert Luthuli Central Hospital in Durban

Imaging findings and outcomes in patients with carotid cavernous fistula at Inkosi Albert Luthuli Central Hospital in Durban

Traumatic cerebrovascular injury: clinical characteristics and illustrative cases

Rare Recurrence of Traumatic Carotid Cavernous Fistula after Parent Artery Occlusion—Report of Two Cases and Review of Literature

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