BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular ...BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons,coils,liquid embolic agents,covered stents,or flow-diverter stent through arterial or venous approaches.Despite the withdrawal of detachable balloons from the market in the United States since 2004,transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries.However,the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up.AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF.METHODS Between January 2009 and December 2019,79 patients diagnosed with TCCF were treated using detachable latex balloons(GOLDBAL)of four sizes.Pseudoaneurysm sizes were stratified into five grades for analysis.Initial and follow-up assessments involved computed tomography angiography at 1 month,6 month,1 year,and longer intervals for significant cases.Clinical follow-ups occurred semi-annually for 2 years,then annually.Factors analyzed included sex,age,fistula size and location,and balloon size.RESULTS In our cohort of 79 patients treated for TCCF,pseudoaneurysms formed in 67.1%,with classifications ranging from grade 0 to grade 3;no grade 4 or giant pseudoaneurysms were observed.The majority of pseudoaneurysms did not progress in size,and some regressed spontaneously.Calcifications developed in most large pseudoaneurysms over 5-10 years.Parent artery occlusion occurred in 7.6%and recurrent fistulas in 16.5%.The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes,with balloon SP and No.6 significantly associated with its occurrence(P=0.005 and P=0.002,respectively),whereas sex,age,fistula size,location,and the number of balloons used were not significant predictors.CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common,primarily influenced by the size of the balloon used.Despite this,all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.展开更多
Sixty-eight patients with traumatic carotid-cavemous fistula (TCCF) were treated by intravascular embolization. All patients were cured and 94.1% of internal carotid arteries were preserved. Proptosis, bruit and chemo...Sixty-eight patients with traumatic carotid-cavemous fistula (TCCF) were treated by intravascular embolization. All patients were cured and 94.1% of internal carotid arteries were preserved. Proptosis, bruit and chemosis disappeared following embolization. The diagnosis and management of TCCF are also evaluated.展开更多
Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a ...Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2- cyanoacrylate （NBCA）. The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed.展开更多
BACKGROUND A carotid-cavernous fistula(CCF)is an abnormal connection between the internal carotid artery(ICA)and the cavernous sinus.Although direct CCFs typically result from trauma or as an iatrogenic complication o...BACKGROUND A carotid-cavernous fistula(CCF)is an abnormal connection between the internal carotid artery(ICA)and the cavernous sinus.Although direct CCFs typically result from trauma or as an iatrogenic complication of neuroendovascular procedures,they can occur as surgery-related complications after mechanical thrombectomy(MT).With the widespread use of MT in patients with acute ischemic stroke complicated with large vessel occlusion,it is important to document CCF following MT and how to avoid them.In this study,we present a case of a patient who developed a CCF following MT and describe in detail the characteristics of ICA tortuosity in this case.CASE SUMMARY A 60-year-old woman experienced weakness in the left upper and lower limbs as well as difficulty speaking for 4 h.The neurological examination revealed left central facial paralysis and left hemiplegia,with a National Institutes of Health Stroke Scale score of 9.Head magnetic resonance imaging revealed an acute cerebral infarction in the right basal ganglia and radial crown.Magnetic resonance angiography demonstrated an occlusion of the right ICA and middle cerebral artery.Digital subtraction angiography demonstrated distal occlusion of the cervical segment of the right ICA.We performed suction combined with stent thrombectomy.Then,postoperative angiography was performed,which showed a right CCF.One month later,CCF embolization was performed,and the patient’s clinical symptoms have significantly improved 5 mo after the operation.CONCLUSION Although a CCF is a rare complication after MT,it should be considered.Understanding the tortuosity of the internal carotid-cavernous sinus may help predict the complexity of MT and avoid this complication.展开更多
Objective BACKGROUND Spontaneous closure of direct traumatic carotid cavernous fistulas (TCCFs) is rare. A few cases have been reported in literature to be related to diagnostic cerebral angiography and orbital venogr...Objective BACKGROUND Spontaneous closure of direct traumatic carotid cavernous fistulas (TCCFs) is rare. A few cases have been reported in literature to be related to diagnostic cerebral angiography and orbital venography. Several mechanisms have been postulated, including irritation of the vessels from contrast media, compression of the carotid artery and reduced blood pressure from general anesthesia. In our own series of about 400 patients at Ramathibodi Hospital, the incidence is approximately 1.75%.CASE PRESENTATION We present a case, which spontaneous closure occurred during attempted endovascular embolization. A 45-year-old woman with left TCCF was referred to our hospital for endovascular treatment. Cerebral angiogram revealed a small-hole fistula at the posterosuperior wall of C2-3 segment of the LICA. Transarterial balloon failed due to the small size of the fistula and acute retroangulation of the balloon attached microcatheter. Transarterial GDC coil placement into the first venous pouch was then attempted for two times, but was unsuccessful. During repositioning of the microcatheter for a third attempt, spontaneous closure of the fistula was observed and confirmed by control angiogram. CONCLUSION Spontaneous closure of direct traumatic carotid cavernous fistulas may occur during endovascular procedures, which can be caused by dissection of the venous pouch by the microcatheter or coils during manipulation, irritation of the vascular walls from the contrast media and decreased blood pressure from general anesthesia.展开更多
Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct...Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.展开更多
BACKGROUND AND PURPOSE We evaluated our experience in placing detachable coils in the management of spontaneous CCFs due to rupture of a primitive trigeminal artery. Methods A 48-year-old female presented with right c...BACKGROUND AND PURPOSE We evaluated our experience in placing detachable coils in the management of spontaneous CCFs due to rupture of a primitive trigeminal artery. Methods A 48-year-old female presented with right conjunctival chemosis and right abducens nerve paresis. Cerebral angiography demonstrated a right carotid-cavernous sinus fistula associated with persistent primitive trigeminal artery. Transvenous routes to the sinus were failed due to the tortuous facial vein. The fistula was treated by Matrix detachable coils and Fibered detachable coils through the transarterial approach. Results The patient was successfully treated by means of transarterial embolization, and symptoms improved within a week. Conclusions Although other techniques using a transvenous approach may also be useful, transarterial embolization with detachable coils should be a safe and effective method to immediately occlude the fistula.展开更多
Objective To explore the method and safety of endovascular treatment of traumatic direct carotid cavernous fistulas with n-Butyl-2-Cyanoacrylate. Method A total of 11 patients with traumatic direct carotid cavernous f...Objective To explore the method and safety of endovascular treatment of traumatic direct carotid cavernous fistulas with n-Butyl-2-Cyanoacrylate. Method A total of 11 patients with traumatic direct carotid cavernous fistulas treated by endovascular embolization with n-Butyl-2-Cyanoacrylate. (n-BCA) were retrospectively analyzed,including the展开更多
Dear Editor,We report a case of traumatic carotid cavernous fistula(CCF)that initially presented in the Ophthalmology Department because of the ocular manifestations.CFF is a clinical syndrome characterized by ocular ...Dear Editor,We report a case of traumatic carotid cavernous fistula(CCF)that initially presented in the Ophthalmology Department because of the ocular manifestations.CFF is a clinical syndrome characterized by ocular abnormalities,which is caused by abnormal communication between the cavernous sinus and the cavernous segment or other meningeal branches of the internal carotid artery(ICA)due to traumatic or spontaneous factors.展开更多
Carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus. The fistula is classified based on its etiology, haemodynamic and anatomical configuration. The most common ty...Carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus. The fistula is classified based on its etiology, haemodynamic and anatomical configuration. The most common type is the direct high flow fistula resulting from trauma. Indirect fistula which is less common results from underlying conditions such as hypertension, collagen vascular diseases, pregnancy amongst others. It is in regards with this uncommon occurrence of indirect fistula that we report a case of forty year</span><span>s</span><span> old woman who presented with a left protruding eyeball and headache a month after delivery and was diagnosed with spontaneous type D indirect carotid cavernous fistula with rapidly progressing symptoms. She was referred abroad for interventional radiological services due to unavailability of such services in our facility and country.展开更多
Background Spontaneous direct carotid-cavernous fistula （CCF） is relatively rare and few reports have been found in the literature. The aim of this paper was to report the clinical characteristics, imaging findings ...Background Spontaneous direct carotid-cavernous fistula （CCF） is relatively rare and few reports have been found in the literature. The aim of this paper was to report the clinical characteristics, imaging findings and curative effect of endovascular treatment for patients with spontaneous direct CCF. Methods We retrospectively analyzed the clinical data of nine patients with spontaneous direct CCF admitted between May 2003 and November 2007 and the outcomes.of endovascular treatment. Sudden neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis （n=8）. No patients had a history of head trauma. Cerebral digital subtraction angiography （DSA） was performed on all cases under local anesthesia and seven cases received endovascular treatment. Results In eight patients, internal carotid angiograms recorded during the early arterial phase revealed aneurysms located in the cavernous sinuses, and in one patient, a dilated internal carotid artery （ICA） was seen. Among the nine cases, seven received endovascular treatment via a transarterial approach and complete occlusion of the fistula was obtained with no technique-related complications, one died suddenly before treatment and one gave up treatment. A detachable balloon was used as the embolic material in two cases, a detachable balloon and detachable coil as the embolic material in two cases, balloon-assisted coil embolization in two cases and covered stents were successfully placed in the parent vessel to exclude the aneurysm and fistula from circulation in one case. During a follow-up period of 3-48 months, all treated patients remained asymptomatic except for one patient who suffered from ipsilateral decreased vision. Conclusions Most spontaneous direct CCF may be caused by a ruptured intracavernous aneurysm with direct shunting into the cavernous sinus. Endovascular treatment seems to be a safe and effective method for treating spontaneous direct CCF.展开更多
Background:The development of carotid-cavernous fistulas(CCFs)during surgical recanalization of chronic internal carotid artery occlusion(ICAO)may be secondary to severe ICA dissection rather than a focal tear of the ...Background:The development of carotid-cavernous fistulas(CCFs)during surgical recanalization of chronic internal carotid artery occlusion(ICAO)may be secondary to severe ICA dissection rather than a focal tear of the cavernous ICA seen in typical traumatic CCFs.The purpose of this study is to investigate the causal relationship between the CCFs and severe ICA dissections and to characterize technical outcomes after treatment with stenting.Methods:Five patients underwent treatment with self-expanding stents due to intraprocedural CCF and ICA dissection following surgical removal of ICAO plaque.The stents were telescopically placed via true channel of the dissection.Safety of the procedure was evaluated with 30-day stroke and death rate.Procedural success was determined by the efficacy of CCF obliteration and ICAO recanalization with angiography.Results:All CCFs were associated with spiral and long segmental dissection from the cervical to cavernous ICA.After stenting,successful dissection reconstruction with TICI 3 was achieved in all patients,with complete(n=4)or partial CCF(n=1)obliteration.No patient had CCF syndrome,stroke,or death during follow-up of 6 to 37 months;but one patient had pulsatile tinnitus,which resolved 1 year later.Angiography at 6 to 24 months demonstrated CCF obliteration in all 5 patients and durable ICA patency in 4 patients.Conclusions:Intraprocedural CCFs with spiral and cervical-to-cavernous ICA dissection during ICAO surgery are dissection-related because of successful obliteration after stenting for dissection reconstruction.Self-expanding stenting through true channel of the dissection,serving as implanting stent-autograft,may be an optimal therapy for the atypical CCF complication from ICAO surgery.展开更多
文摘BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons,coils,liquid embolic agents,covered stents,or flow-diverter stent through arterial or venous approaches.Despite the withdrawal of detachable balloons from the market in the United States since 2004,transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries.However,the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up.AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF.METHODS Between January 2009 and December 2019,79 patients diagnosed with TCCF were treated using detachable latex balloons(GOLDBAL)of four sizes.Pseudoaneurysm sizes were stratified into five grades for analysis.Initial and follow-up assessments involved computed tomography angiography at 1 month,6 month,1 year,and longer intervals for significant cases.Clinical follow-ups occurred semi-annually for 2 years,then annually.Factors analyzed included sex,age,fistula size and location,and balloon size.RESULTS In our cohort of 79 patients treated for TCCF,pseudoaneurysms formed in 67.1%,with classifications ranging from grade 0 to grade 3;no grade 4 or giant pseudoaneurysms were observed.The majority of pseudoaneurysms did not progress in size,and some regressed spontaneously.Calcifications developed in most large pseudoaneurysms over 5-10 years.Parent artery occlusion occurred in 7.6%and recurrent fistulas in 16.5%.The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes,with balloon SP and No.6 significantly associated with its occurrence(P=0.005 and P=0.002,respectively),whereas sex,age,fistula size,location,and the number of balloons used were not significant predictors.CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common,primarily influenced by the size of the balloon used.Despite this,all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.
文摘Sixty-eight patients with traumatic carotid-cavemous fistula (TCCF) were treated by intravascular embolization. All patients were cured and 94.1% of internal carotid arteries were preserved. Proptosis, bruit and chemosis disappeared following embolization. The diagnosis and management of TCCF are also evaluated.
文摘Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2- cyanoacrylate （NBCA）. The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed.
文摘BACKGROUND A carotid-cavernous fistula(CCF)is an abnormal connection between the internal carotid artery(ICA)and the cavernous sinus.Although direct CCFs typically result from trauma or as an iatrogenic complication of neuroendovascular procedures,they can occur as surgery-related complications after mechanical thrombectomy(MT).With the widespread use of MT in patients with acute ischemic stroke complicated with large vessel occlusion,it is important to document CCF following MT and how to avoid them.In this study,we present a case of a patient who developed a CCF following MT and describe in detail the characteristics of ICA tortuosity in this case.CASE SUMMARY A 60-year-old woman experienced weakness in the left upper and lower limbs as well as difficulty speaking for 4 h.The neurological examination revealed left central facial paralysis and left hemiplegia,with a National Institutes of Health Stroke Scale score of 9.Head magnetic resonance imaging revealed an acute cerebral infarction in the right basal ganglia and radial crown.Magnetic resonance angiography demonstrated an occlusion of the right ICA and middle cerebral artery.Digital subtraction angiography demonstrated distal occlusion of the cervical segment of the right ICA.We performed suction combined with stent thrombectomy.Then,postoperative angiography was performed,which showed a right CCF.One month later,CCF embolization was performed,and the patient’s clinical symptoms have significantly improved 5 mo after the operation.CONCLUSION Although a CCF is a rare complication after MT,it should be considered.Understanding the tortuosity of the internal carotid-cavernous sinus may help predict the complexity of MT and avoid this complication.
文摘Objective BACKGROUND Spontaneous closure of direct traumatic carotid cavernous fistulas (TCCFs) is rare. A few cases have been reported in literature to be related to diagnostic cerebral angiography and orbital venography. Several mechanisms have been postulated, including irritation of the vessels from contrast media, compression of the carotid artery and reduced blood pressure from general anesthesia. In our own series of about 400 patients at Ramathibodi Hospital, the incidence is approximately 1.75%.CASE PRESENTATION We present a case, which spontaneous closure occurred during attempted endovascular embolization. A 45-year-old woman with left TCCF was referred to our hospital for endovascular treatment. Cerebral angiogram revealed a small-hole fistula at the posterosuperior wall of C2-3 segment of the LICA. Transarterial balloon failed due to the small size of the fistula and acute retroangulation of the balloon attached microcatheter. Transarterial GDC coil placement into the first venous pouch was then attempted for two times, but was unsuccessful. During repositioning of the microcatheter for a third attempt, spontaneous closure of the fistula was observed and confirmed by control angiogram. CONCLUSION Spontaneous closure of direct traumatic carotid cavernous fistulas may occur during endovascular procedures, which can be caused by dissection of the venous pouch by the microcatheter or coils during manipulation, irritation of the vascular walls from the contrast media and decreased blood pressure from general anesthesia.
文摘Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.
文摘BACKGROUND AND PURPOSE We evaluated our experience in placing detachable coils in the management of spontaneous CCFs due to rupture of a primitive trigeminal artery. Methods A 48-year-old female presented with right conjunctival chemosis and right abducens nerve paresis. Cerebral angiography demonstrated a right carotid-cavernous sinus fistula associated with persistent primitive trigeminal artery. Transvenous routes to the sinus were failed due to the tortuous facial vein. The fistula was treated by Matrix detachable coils and Fibered detachable coils through the transarterial approach. Results The patient was successfully treated by means of transarterial embolization, and symptoms improved within a week. Conclusions Although other techniques using a transvenous approach may also be useful, transarterial embolization with detachable coils should be a safe and effective method to immediately occlude the fistula.
文摘Objective To explore the method and safety of endovascular treatment of traumatic direct carotid cavernous fistulas with n-Butyl-2-Cyanoacrylate. Method A total of 11 patients with traumatic direct carotid cavernous fistulas treated by endovascular embolization with n-Butyl-2-Cyanoacrylate. (n-BCA) were retrospectively analyzed,including the
文摘Dear Editor,We report a case of traumatic carotid cavernous fistula(CCF)that initially presented in the Ophthalmology Department because of the ocular manifestations.CFF is a clinical syndrome characterized by ocular abnormalities,which is caused by abnormal communication between the cavernous sinus and the cavernous segment or other meningeal branches of the internal carotid artery(ICA)due to traumatic or spontaneous factors.
文摘Carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus. The fistula is classified based on its etiology, haemodynamic and anatomical configuration. The most common type is the direct high flow fistula resulting from trauma. Indirect fistula which is less common results from underlying conditions such as hypertension, collagen vascular diseases, pregnancy amongst others. It is in regards with this uncommon occurrence of indirect fistula that we report a case of forty year</span><span>s</span><span> old woman who presented with a left protruding eyeball and headache a month after delivery and was diagnosed with spontaneous type D indirect carotid cavernous fistula with rapidly progressing symptoms. She was referred abroad for interventional radiological services due to unavailability of such services in our facility and country.
文摘Background Spontaneous direct carotid-cavernous fistula （CCF） is relatively rare and few reports have been found in the literature. The aim of this paper was to report the clinical characteristics, imaging findings and curative effect of endovascular treatment for patients with spontaneous direct CCF. Methods We retrospectively analyzed the clinical data of nine patients with spontaneous direct CCF admitted between May 2003 and November 2007 and the outcomes.of endovascular treatment. Sudden neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis （n=8）. No patients had a history of head trauma. Cerebral digital subtraction angiography （DSA） was performed on all cases under local anesthesia and seven cases received endovascular treatment. Results In eight patients, internal carotid angiograms recorded during the early arterial phase revealed aneurysms located in the cavernous sinuses, and in one patient, a dilated internal carotid artery （ICA） was seen. Among the nine cases, seven received endovascular treatment via a transarterial approach and complete occlusion of the fistula was obtained with no technique-related complications, one died suddenly before treatment and one gave up treatment. A detachable balloon was used as the embolic material in two cases, a detachable balloon and detachable coil as the embolic material in two cases, balloon-assisted coil embolization in two cases and covered stents were successfully placed in the parent vessel to exclude the aneurysm and fistula from circulation in one case. During a follow-up period of 3-48 months, all treated patients remained asymptomatic except for one patient who suffered from ipsilateral decreased vision. Conclusions Most spontaneous direct CCF may be caused by a ruptured intracavernous aneurysm with direct shunting into the cavernous sinus. Endovascular treatment seems to be a safe and effective method for treating spontaneous direct CCF.
基金This work was supported by the National Natural Science Foundation of China(grant no.81471767,81871464).
文摘Background:The development of carotid-cavernous fistulas(CCFs)during surgical recanalization of chronic internal carotid artery occlusion(ICAO)may be secondary to severe ICA dissection rather than a focal tear of the cavernous ICA seen in typical traumatic CCFs.The purpose of this study is to investigate the causal relationship between the CCFs and severe ICA dissections and to characterize technical outcomes after treatment with stenting.Methods:Five patients underwent treatment with self-expanding stents due to intraprocedural CCF and ICA dissection following surgical removal of ICAO plaque.The stents were telescopically placed via true channel of the dissection.Safety of the procedure was evaluated with 30-day stroke and death rate.Procedural success was determined by the efficacy of CCF obliteration and ICAO recanalization with angiography.Results:All CCFs were associated with spiral and long segmental dissection from the cervical to cavernous ICA.After stenting,successful dissection reconstruction with TICI 3 was achieved in all patients,with complete(n=4)or partial CCF(n=1)obliteration.No patient had CCF syndrome,stroke,or death during follow-up of 6 to 37 months;but one patient had pulsatile tinnitus,which resolved 1 year later.Angiography at 6 to 24 months demonstrated CCF obliteration in all 5 patients and durable ICA patency in 4 patients.Conclusions:Intraprocedural CCFs with spiral and cervical-to-cavernous ICA dissection during ICAO surgery are dissection-related because of successful obliteration after stenting for dissection reconstruction.Self-expanding stenting through true channel of the dissection,serving as implanting stent-autograft,may be an optimal therapy for the atypical CCF complication from ICAO surgery.
