Results of Endovascular Treatment for High-Flow Direct Carotid-Cavernous Fistulas
https://doi.org/10.20862/0042-4676-2020-101-5-283-287
Abstract
Objective: to study the results of treatment in patients with direct high-flow carotid-cavernous fistulas with their transarterial occlusion using detachable balloons and microcoils.
Material and methods. Thirty-five patients underwent surgery using detachable balloons and microcoils. The clinical picture in all patients was represented by pulsating exophthalmos, ptosis on the side of the lesion, ophthalmoplegia, and conjunctival chemosis.
Results. In all patients closure of carotid-cavernous fistulas and reversal of symptoms were achieved after primary surgery. Internal carotid artery reconstruction with microcoils could be achieved significantly more often than that with balloons. An anastomotic recurrence was significantly more common in patients undergoing surgery with balloons.
Conclusion. The use of microcoils allows to perform reconstructive surgery significantly more frequently, while the recurrence rate is significantly lower than after using the balloons.
About the Authors
A. E. Petrov
Polenov Russian Scienific Research Institute of Neurosurgery - Branch of Almazov National Medical Research Centre, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Andrey E. Petrov - Cand. Med. Sc., Head of Department.
Ul. Mayakovskogo, 12, Saint-Petersburg, 191014
S. А. Goroshchenko
Polenov Russian Scienific Research Institute of Neurosurgery - Branch of Almazov National Medical Research Centre, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Andrey E. Petrov - Cand. Med. Sc., Head of Department.
Ul. Mayakovskogo, 12, Saint-Petersburg, 191014
L. V. Rozhchenko
Polenov Russian Scienific Research Institute of Neurosurgery - Branch of Almazov National Medical Research Centre, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Andrey E. Petrov - Cand. Med. Sc., Head of Department.
Ul. Mayakovskogo, 12, Saint-Petersburg, 191014
K. A. Samochernykh
Polenov Russian Scienific Research Institute of Neurosurgery - Branch of Almazov National Medical Research Centre, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Andrey E. Petrov - Cand. Med. Sc., Head of Department.
Ul. Mayakovskogo, 12, Saint-Petersburg, 191014
References
1. Yakovlev SB, Bocharov AV, Bukharin EYu, Arustamian SR, Arkhangelskaya YaN. Direct carotid-cavernous fistulas: clinical presentation, angioarchitectonics and endovascular management. Burdenko's Journal of Neurosurgery. 2008; 4: 3-11 (in Russian).
2. Wendl CM, Henkes H, Martinez Moreno R, Ganslandt O, Bazner H, Aguilar Perez M. Direct carotid cavernous sinus fistulae: vessel reconstruction using flow-diverting implants. Clin Neuroradiol. 2017; 27(4): 493-501. doi: 10.1007/s00062-016-0511-6
3. Masson-Roy J, Savard M, Mackey A. Carotid cavernous fistula in a patient with type IV Ehlers-Danlos syndrome. Can J Neurol Sci. 2017; 44(4): 1-2. doi: 10.1017/cjn.2016.456
4. Ono K, Oishi H, Tanoue S, Hasegawa H, Yoshida K, Yamamoto M., Arai H. Direct carotid-cavernous fistulas occurring during neurointerventional procedures. Interv Neuroradiol. 2016; 22(1): 91-6. doi: 10.1177/1591019915617321
5. Vinuela F, Fox AJ, Debrun GM, Peerless SJ, Drake CG. Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations: experience with 20 cases. J Neurosurg. 1984; 60(5): 976-84. doi: 10.3171/jns.1984.60.5.0976
6. Halbach VV, Hieshima GB, Higashida RT, Reicher M. Carotid cavernous fistulae: indications for urgent treatment. AJR Am J Roentgenol. 1987; 149(3): 587-93. doi: 10.2214/ajr.149.3.587
7. Miller NR. Diagnosis and management of dural carotid-cavernous sinus fistulas. Neurosurg Focus. 2007; 23(5): E13. doi: 10.3171/foc-07/11/e13
8. Gemmete JJ, Ansari SA, Gandhi DM. Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol. 2009; 29: 62-71. doi: 10.1097/WN0.0b013e3181989fc0
9. Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg. 1974; 41: 125-45. doi: 10.3171/jns.1974.41.2.0125
10. Castano C, Remollo S, Garcia-Sort R, Dominguez C, Tercen M. Treatment of Barrow type ‘B' carotid cavernous fistulas with flow diverter stent (Pipeline). Neuroradiol J. 2017; 30(6): 607-14. doi: 10.1177/1971400917695319
11. Ringer AJ, Salud L, Tomsick TA. Carotid cavernous fistulas: anatomy, classification, and treatment. Neurosurg Clin N Am. 2005; 16: 279-95. doi: 10.1016/j.nec.2004.08.004
12. Sencer S, Minareci O, Poyanli A. Management of a rare complication of endovascular treatment of direct carotid cavernous fistula. AJNR Am J Neuroradiol. 1999; 20: 1465-6.
13. Klisch J, Schipper J, Husstedt H, Laszig R, Schumacher M. Transsphenoidal computer-navigation-assisted deflation of a balloon after endovascular occlusion of a direct carotid cavernous sinus fistula. AJNR Am J Neuroradiol. 2001; 22: 537-40.
14. Tjoumakaris SI, Jabbour PM, Rosenwasser RH. Neuroendovascular management of carotid cavernous fistulae. Neurosurg Clin N Am. 2009; 20: 447-52. doi: 10.1016/j.nec.2009.07.013
15. Kocer N, Kizilkilic O, Albayram S, Adaletli I, Kantarci F, Islak C. Treatment of iatrogenic internal carotid artery laceration and carotid cavernous fistula with endovascular stentgraft placement. AJNR Am J Neuroradiol. 2002; 23(3): 442-6.
16. Gomez F, Escobar W, Gomez AM, Gomez JF, Anaya CA. Treatment of carotid cavernous fistulas using covered stents: midterm results in seven patients. AJNR Am J Neuroradiol. 2007; 28(9): 1762-8. doi: 10.3174/ajnr.A0636
17. Kallmes DF, Cloft HJ. The use of hydrocoil for parent artery occlusion. AJNR Am J Neuroradiol. 2004; 25(8): 1409-10.
18. Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of carotid cavernous sinus fistula: a systematic review. World J Radiol. 2013; 5(4): 143-55. doi: 10.4329/wjr.v5.i4.143
19. Gao BL, Wang ZL, Li TX, Xu B. Recurrence risk factors in detachable balloon embolization of traumatic direct carotid cavernous fistulas in 188 patients. J Neurointerv Surg. 2017. doi: 10.1136/neurintsurg-2017-013384
20. Moron FE, Klucznik RP, Mawad ME, Strother CM. Endovascular treatment of high-flow carotid cavernous fistulas by stent-assisted coil placement. AJNR Am J Neuroradiol. 2005; 26(6): 1399-404.
21. He XH, Li WT, Peng WJ, Lu JP, Liu Q Zhao R. Endovascular treatment of posttraumatic carotid-cavernous fistulas and pseudoaneurysms with covered stents. J Neuroimag. 2014; 24(3): 287-91. doi: 10.1111/jon.12023
22. Hoit DA, Schirmer CM, Malek AM. Stent graft treatment of cerebrovascular wall defects: intermediate-term clinical and angiographic results. Neurosurgery. 2008; 62(5 Suppl 2): ONS380-8. doi: 10.1227/01.neu.0000326022.08973.b2
23. Cuong Tran Chi. Endovascular treatment of traumatic carotid cavernous fistulas: review of 172 consecutive cases. Interv Neuroradiol. 2011; 17 (Suppl 1): 77.
24. Berenstein A, Lasjaunias P, Ter Brugge KG. Surgical neuroangiography. Vol. 2. 2nd ed. Springer; 2004: 279-333. doi: 10.1007/978-3-642-18888-6
Review
For citations:
Petrov A.E., Goroshchenko S.А., Rozhchenko L.V., Samochernykh K.A. Results of Endovascular Treatment for High-Flow Direct Carotid-Cavernous Fistulas. Journal of radiology and nuclear medicine. 2020;101(5):283-287. (In Russ.) https://doi.org/10.20862/0042-4676-2020-101-5-283-287
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