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Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature
- Source :
- Journal of neurointerventional surgery. 9(2)
- Publication Year :
- 2016
-
Abstract
- ObjectiveCarotid cavernous fistula (CCF) development after Pipeline Embolization Device (PED) treatment of cavernous carotid aneurysms (CCA) can be a challenging pathology to treat for the neurointerventionalist.MethodsA database of all patients whose aneurysms were treated with the PED since its approval by the Food and Drug Administration in 2011 was retrospectively reviewed. Demographic information, aneurysm characteristics, treatment technique, antiplatelet regimen, and follow-up data were collected. A literature review of all papers that describe PED treatment of CCA was then completed.ResultsA total of 44 patients with 45 CCAs were identified (38 women, 6 men). The mean age was 59.9±9.0 years. The mean maximal aneurysm diameter was 15.9±6.9 mm (mean neck 7.1±3.6 mm). A single PED was deployed in 32 patients, with two PEDs deployed in 10 patients and three PEDs in 3 patients. Adjunctive coiling was performed in 3 patients. Mean follow-up duration based on final imaging (MR angiography or digital subtraction angiography) was 14.1±12.2 months. Five patients (11.4%) developed CCFs in the post-procedural period after PED treatment, all within 2 weeks of device placement. These CCFs were treated with a balloon test occlusion followed by parent artery sacrifice. Our literature review yielded only three reports of CCFs after PED placement, with the largest series having a CCF rate of 2.3%.ConclusionsCCF formation is a known risk of PED treatment of CCA. Although transvenous embolization can be used for treating CCFs, parent artery sacrifice remains a viable option on the basis of these data. Studies support the view that adjunctive coiling may have a protective effect against post-PED CCF formation. None of the coiled aneurysms in our database or in the literature have ruptured. Follow-up data will lead to a better understanding of the safety profile of the PED for CCA.
- Subjects :
- Male
medicine.medical_specialty
Transvenous embolization
medicine.medical_treatment
Single Center
Neurosurgical Procedures
030218 nuclear medicine & medical imaging
03 medical and health sciences
Blood Vessel Prosthesis Implantation
0302 clinical medicine
Aneurysm
Carotid-Cavernous Sinus Fistula
medicine
Oculomotor Nerve Diseases
Humans
Embolization
Carotid-cavernous fistula
Aged
Retrospective Studies
medicine.diagnostic_test
business.industry
Angiography, Digital Subtraction
Intracranial Aneurysm
General Medicine
Digital subtraction angiography
Balloon Occlusion
Middle Aged
medicine.disease
Surgery
Blood Vessel Prosthesis
Cerebral Angiography
Safety profile
Regimen
Treatment Outcome
Fluoroscopy
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
Carotid Artery, Internal
Magnetic Resonance Angiography
Platelet Aggregation Inhibitors
Follow-Up Studies
Subjects
Details
- ISSN :
- 17598486
- Volume :
- 9
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Journal of neurointerventional surgery
- Accession number :
- edsair.doi.dedup.....115b253c3424d8da3c2405f53665ceab