Embolization of carotid-cavernous fistulas: A technical note on simultaneous balloon protection of the internal carotid artery. (August 2020)

• Record Type: Journal Article
• Authors: Zeineddine, Hussein A.; Lopez-Rivera, Victor; Conner, Christopher R.; Sheriff, Faheem G.; Choi, Phillip A.; Inam, Mehmet E.; Cochran, Joseph; Chen, Peng Roc
• Is Part Of: Journal of clinical neuroscience. Volume 78(2020)
• Page Start: 389
• Page End: 392
• Publication Date: 2020-08
• Subjects: Carotid-cavernous fistula -- Endovascular therapy -- Onyx embolization -- Internal carotid artery protection; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.04.015
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Carotid-cavernous fistulas are complex entities difficult to obliterate. A common cause of recurrence is failure to achieve complete obliteration. Infusion of embolic agents pose a risk of reflux into the arterial circulation. Concurrent balloon protection of the internal carotid artery prevents such risk. Abstract: A carotid-cavernous fistula (CCF) is an abnormal connection between the carotid circulation and the cavernous sinus. Treatment of CCFs often consists of obliteration of the fistula by a transarterial or transvenous endovascular approach using embolic agents. However, fistula embolization is often halted due to the potential embolic complications that may arise from the retrograde flow of the embolic agents into the arterial circulation, which often leads to the development of fistula recurrence. Moreover, retreatment of a CCF recurrence is challenging and more complex approaches may be required. In this technical note, we describe our experience with CCF embolization in 25 patients treated at a single center. We utilized a transvenous approach for CCF embolization with simultaneous balloon occlusion of the internal carotid artery during the infusion of the embolic material into the fistula. In our series, this simultaneous protection of the internal carotid artery showed to be a safe technique to prevent embolic complications and to achieve successful obliteration of the fistula. On follow-up, 2 cases presented a recurrence, one due to technical difficulties and the other related to an undetected vascular injury. In conclusion, this technique provides a safe approach in the treatment of CCFs by decreasing the risk of embolic complications and increasing the effectiveness of the embolic agents in accomplishing the obliteration of the CCF.