Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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First line Treatment of Traumatic Carotid Cavernous Fistulas Using Covered Stents at Level 1 Regional Trauma Center

  • Jeong, Sang Hoon (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Lee, Jung Hwan (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Choi, Hyuk Jin (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Kim, Byung Chul (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Yu, Seung Han (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Lee, Jae Il (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2020.12.11
  • Accepted : 2021.04.07
  • Published : 2021.09.01
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Abstract

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.

Keywords

Acknowledgement

This work was supported by Biomedical Research Institute Grant (2021) of Pusan National University Hospital.

References

  1. Ahn JY, Lee BH, Joo JY : Stent-assisted Guglielmi detachable coils embolisation for the treatment of a traumatic carotid cavernous fistula. J Clin Neurosci 10 : 96-98, 2003 https://doi.org/10.1016/S0967-5868(02)00266-7
  2. 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
  3. Carter BS, Ogilvy CS, Putman C, Ojemann RG : Selective use of extracranial-intracranial bypass as an adjunct to therapeutic internal carotid artery occlusion. Clin Neurosurg 46 : 351-362, 2000
  4. Chi CT, Nguyen D, Duc VT, Chau HH, Son VT : Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases. Interv Neuroradiol 20 : 461-475, 2014 https://doi.org/10.15274/INR-2014-10020
  5. Choi BJ, Lee TH, Kim CW, Choi CH : Endovascular graft-stent placement for treatment of traumatic carotid cavernous fistulas. J Korean Neurosurg Soc 46 : 572-576, 2009 https://doi.org/10.3340/jkns.2009.46.6.572
  6. Cox DE, Jacobs DL, Motaganahalli RL, Wittgen CM, Peterson GJ : Outcomes of endovascular AAA repair in patients with hostile neck anatomy using adjunctive balloon-expandable stents. Vasc Endovascular Surg 40 : 35-40, 2006 https://doi.org/10.1177/153857440604000105
  7. Debrun G, Lacour P, Caron JP, Hurth M, Comoy J, Keravel Y : Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions. J Neurosurg 49 : 635-634, 1978 https://doi.org/10.3171/jns.1978.49.5.0635
  8. 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
  9. Diethrich EB : The bumpy road is over. Endoluminal grafts for abdominal aortic aneurysm repair will be the gold standard. J Cardiovasc Surg (Torino) 47 : 235-237, 2006
  10. Fattahi TT, Brandt MT, Jenkins WS, Steinberg B : Traumatic carotidcavernous fistula: pathophysiology and treatment. J Craniofac Surg 14 : 240-246, 2003 https://doi.org/10.1097/00001665-200303000-00020
  11. Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, et al. : Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. Am J Surg 212 : 1167-1174, 2016 https://doi.org/10.1016/j.amjsurg.2016.09.016
  12. 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
  13. 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
  14. Higashida R, Halbach V, Tsai F, Norman D, Pribram H, Mehringer C, et al. : Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases. Am J Roentgenol 153 : 577-582, 1989 https://doi.org/10.2214/ajr.153.3.577
  15. Higashida RT, Halbach VV, Dowd C, Barnwell SL, Dormandy B, Bell J, et al. : Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg 72 : 857-863, 1990 https://doi.org/10.3171/jns.1990.72.6.0857
  16. Hoit DA, Schirmer CM, Malek AM : Stent graft treatment of cerebrovascular wall defects: intermediate-term clinical and angiographic results. Neurosurgery 62 : ONS380-ONS388; discussion ONS388-ONS389, 2008
  17. Kim DY, Biffl W, Bokhari F, Brakenridge S, Chao E, Claridge JA, et al. : Evaluation and management of blunt cerebrovascular injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 88 : 875-887, 2020 https://doi.org/10.1097/TA.0000000000002668
  18. 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 22 : 537-540, 2001
  19. 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
  20. Kobayashi N, Miyachi S, Negoro M, Suzuki O, Hattori K, Kojima T, et al. : Endovascular treatment strategy for direct carotid-cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. AJNR Am J Neuroradiol 24 : 1789-1796, 2003
  21. Kupersmith MJ, Hurst R, Berenstein A, Choi IS, Jafar J, Ransohoff J : The benign course of cavernous carotid artery aneurysms. J Neurosurg 77 : 690-693, 1992 https://doi.org/10.3171/jns.1992.77.5.0690
  22. Law Y, Chan YC, Cheng SW : Effectiveness of proximal intra-operative salvage Palmaz stent placement for endoleak during endovascular aneurysm repair. Hong Kong Med J 22 : 538-545, 2016
  23. Lewis AI, Tomsick TA, Tew JM Jr : Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons. Neurosurgery 36 : 239-244; discussion 244-245, 1995 https://doi.org/10.1227/00006123-199502000-00001
  24. Lewis AI, Tomsick TA, Tew JM Jr, Lawless MA : Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons. J Neurosurg 84 : 400-404, 1996 https://doi.org/10.3171/jns.1996.84.3.0400
  25. 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
  26. Li K, Cho YD, Kim KM, Kang HS, Kim JE, Han MH : Covered stents for the endovascular treatment of a direct carotid cavernous fistula : single center experiences with 10 cases. J Korean Neurosurg Soc 57 : 12-18, 2015 https://doi.org/10.3340/jkns.2015.57.1.12
  27. Liang W, Xiaofeng Y, Weiguo L, Wusi Q, Gang S, Xuesheng Z : Traumatic carotid cavernous fistula accompanying basilar skull fracture: a study on the incidence of traumatic carotid cavernous fistula in the patients with basilar skull fracture and the prognostic analysis about traumatic carotid cavernous fistula. J Trauma 63 : 1014-1020; discussion 1020, 2007 https://doi.org/10.1097/TA.0b013e318154c9fb
  28. Lu X, Hussain M, Ni L, Huang Q, Zhou F, Gu Z, et al. : A comparison of different transarterial embolization techniques for direct carotid cavernous fistulas: a single center experience in 32 patients. J Vasc Interv Neurol 7 : 35-47, 2014
  29. 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
  30. Mahalingam HV, Mani SE, Patel B, Prabhu K, Alexander M, Fatterpekar GM, et al. : Imaging spectrum of cavernous sinus lesions with histopathologic correlation. Radiographics 39 : 795-819, 2019 https://doi.org/10.1148/rg.2019180122
  31. Prolo DJ, Hanbery JW : Intraluminal occlusion of a carotid-cavernous sinus fistula with a balloon catheter. Technical note. J Neurosurg 35 : 237-242, 1971 https://doi.org/10.3171/jns.1971.35.2.0237
  32. Qu L, Raithel D : Experience with the endologix powerlink endograft in endovascular repair of abdominal aortic aneurysms with short and angulated necks. Perspect Vasc Surg Endovasc Ther 20 : 158-166, 2008 https://doi.org/10.1177/1531003508320343
  33. Remonda L, Frigerio SB, Buhler R, Schroth G : Transvenous coil treatment of a type a carotid cavernous fistula in association with transarterial trispan coil protection. AJNR Am J Neuroradiol 25 : 611-613, 2004
  34. 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
  35. Serbinenko FA : Reconstruction of the cavernous section of the carotid artery in carotid-cavernous anastomosis. Vopr Neirokhir 36 : 3-8, 1972
  36. Suh DC, Lee JH, Kim SJ, Chung SJ, Choi CG, Kim HJ, et al. : New concept in cavernous sinus dural arteriovenous fistula: correlation with presenting symptom and venous drainage patterns. Stroke 36 : 1134-1139, 2005 https://doi.org/10.1161/01.STR.0000166194.82027.63
  37. Takenoshita Y, Hasuo K, Matsushima T, Oka M : Carotid-cavernous sinus fistula accompanying facial trauma. Report of a case with a review of the literature. J Craniomaxillofac Surg 18 : 41-45, 1990 https://doi.org/10.1016/S1010-5182(05)80602-X
  38. 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
  39. van Rooij WJ, Sluzewski M, Beute GN : Ruptured cavernous sinus aneurysms causing carotid cavernous fistula: incidence, clinical presentation, treatment, and outcome. AJNR Am J Neuroradiol 27 : 185-189, 2006
  40. 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
  41. Wang YL, Ma J, Ding PX, Li YD, Han XW, Wu G : Treatment of posttraumatic carotid-cavernous fistulas with the Willis covered stent. A preliminary prospective study. Interv Neuroradiol 18 : 172-177, 2012 https://doi.org/10.1177/159101991201800208
  42. 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 27 : 493-501, 2017 https://doi.org/10.1007/s00062-016-0511-6
  43. White GH, Yu W, May J : Endoleak--a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg 3 : 123-125, 1996 https://doi.org/10.1583/1074-6218(1996)003<0123:>2.0.CO;2
  44. Zachariades N, Papavassiliou D : Traumatic carotid-cavernous sinus fistula. J Craniomaxillofac Surg 16 : 385-388, 1988 https://doi.org/10.1016/S1010-5182(88)80086-6