Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Covered Stents for the Endovascular Treatment of a Direct Carotid Cavernous Fistula : Single Center Experiences with 10 Cases

  • Li, Ke (Department of Interventional Radiology, 1st Affiliated Hospital of Dalian Medical University) ;
  • Cho, Young Dae (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Kang Min (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kang, Hyun-Seung (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Jeong Eun (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Han, Moon Hee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2014.01.14
  • Accepted : 2014.04.15
  • Published : 2015.01.28
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Abstract

Objective : Covered 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. Methods : From February 2009 through July 2013, 10 patients underwent covered stent placement for a DCCF occlusion. Clinical and angiographic data were retrospectively reviewed. Results : Covered 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. Conclusion : Although 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.

Keywords

References

  1. Archondakis E, Pero G, Valvassori L, Boccardi E, Scialfa G : Angiographic follow-up of traumatic carotid cavernous fistulas treated with endovascular stent graft placement. AJNR Am J Neuroradiol 28 : 342-347, 2007
  2. Briguori C, Sarais C, Sivieri G, Takagi T, Di Mario C, Colombo A : Polytetrafluoroethylene-covered stent and coronary artery aneurysms. Catheter Cardiovasc Interv 55 : 326-330, 2002 https://doi.org/10.1002/ccd.10063
  3. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP : Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 331 : 1729-1734, 1994 https://doi.org/10.1056/NEJM199412293312601
  4. Debrun G, Lacour P, Vinuela F, Fox A, Drake CG, Caron JP : Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 55 : 678-692, 1981 https://doi.org/10.3171/jns.1981.55.5.0678
  5. Gemmete JJ, Ansari SA, Gandhi DM : Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol 29 : 62-71, 2009 https://doi.org/10.1097/WNO.0b013e3181989fc0
  6. 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 28 : 1762-1768, 2007 https://doi.org/10.3174/ajnr.A0636
  7. Gupta AK, Purkayastha S, Krishnamoorthy T, Bodhey NK, Kapilamoorthy TR, Kesavadas C, et al. : Endovascular treatment of direct carotid cavernous fistulae : a pictorial review. Neuroradiology 48 : 831-839, 2006 https://doi.org/10.1007/s00234-006-0132-x
  8. Halbach VV, Higashida RT, Barnwell SL, Dowd CF, Hieshima GB : Transarterial platinum coil embolization of carotid-cavernous fistulas. AJNR Am J Neuroradiol 12 : 429-433, 1991
  9. Hoit DA, Schirmer CM, Malek AM : Stent graft treatment of cerebrovascular wall defects : intermediate-term clinical and angiographic results. Neurosurgery 62 (5 Suppl 2) : ONS380-ONS388; discussion ONS388- ONS389, 2008
  10. Klisch J, Huppertz HJ, Spetzger U, Hetzel A, Seeger W, Schumacher M : Transvenous treatment of carotid cavernous and dural arteriovenous fistulae : results for 31 patients and review of the literature. Neurosurgery 53 : 836-856; discussion 856-857, 2003 https://doi.org/10.1227/01.NEU.0000083551.26295.AB
  11. Li J, Lan ZG, Xie XD, You C, He M : Traumatic carotid-cavernous fistulas treated with covered stents : experience of 12 cases. World Neurosurg 73 : 514-519, 2010 https://doi.org/10.1016/j.wneu.2010.02.062
  12. Lukito G, Vandergoten P, Jaspers L, Dendale P, Benit E : Six months clinical, angiographic, and IVUS follow-up after PTFE graft stent implantation in native coronary arteries. Acta Cardiol 55 : 255-260, 2000 https://doi.org/10.2143/AC.55.4.2005748
  13. Luo CB, Teng MM, Yen DH, Chang FC, Lirng JF, Chang CY : Endovascular embolization of recurrent traumatic carotid-cavernous fistulas managed previously with detachable balloons. J Trauma 56 : 1214-1220, 2004 https://doi.org/10.1097/01.TA.0000131213.93205.57
  14. 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 26 : 1399-1404, 2005
  15. Saatci I, Cekirge HS, Ozturk MH, Arat A, Ergungor F, Sekerci Z, et al. : Treatment of internal carotid artery aneurysms with a covered stent : experience in 24 patients with mid-term follow-up results. AJNR Am J Neuroradiol 25 : 1742-1749, 2004
  16. Tiewei Q, Ali A, Shaolei G, Feng L, Zhongsong S, Xuesong L, et al. : Carotid cavernous fistulas treated by endovascular covered stent grafts with follow-up results. Br J Neurosurg 24 : 435-440, 2010 https://doi.org/10.3109/02688697.2010.487127
  17. Wang C, Xie X, You C, Zhang C, Cheng M, He M, et al. : Placement of covered stents for the treatment of direct carotid cavernous fistulas. AJNR Am J Neuroradiol 30 : 1342-1346, 2009 https://doi.org/10.3174/ajnr.A1583
  18. Wang YL, Ma J, Ding PX, Li YD, Han XW, Wu G : Treatment of post-traumatic carotid-cavernous fistulas with the Willis covered stent. A preliminary prospective study. Interv Neuroradiol 18 : 172-177, 2012 https://doi.org/10.1177/159101991201800208
  19. Zhu YQ, Li MH, Lin F, Song DL, Tan HQ, Gu BX, et al. : Frequency and predictors of endoleaks and long-term patency after covered stent placement for the treatment of intracranial aneurysms : a prospective, non-randomised multicentre experience. Eur Radiol 23 : 287-297, 2013 https://doi.org/10.1007/s00330-012-2581-4

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