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Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach

We present a transvenous embolization technique for a direct carotid-cavernous fistula through the pterygoid plexus to the cavernous sinus which only 2 cases have been previously reported in the English literature. This method is appropriate when transarterial techniques or other attempts at transve...

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Autores principales: Ou, Chang-Hsien, Chen, Te-Yuan, Lin, Pei-Ling, Lee, Cheng-Lung, Lin, Wan-Ching
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120854/
https://www.ncbi.nlm.nih.gov/pubmed/34025891
http://dx.doi.org/10.1016/j.radcr.2021.04.036
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author Ou, Chang-Hsien
Chen, Te-Yuan
Lin, Pei-Ling
Lee, Cheng-Lung
Lin, Wan-Ching
author_facet Ou, Chang-Hsien
Chen, Te-Yuan
Lin, Pei-Ling
Lee, Cheng-Lung
Lin, Wan-Ching
author_sort Ou, Chang-Hsien
collection PubMed
description We present a transvenous embolization technique for a direct carotid-cavernous fistula through the pterygoid plexus to the cavernous sinus which only 2 cases have been previously reported in the English literature. This method is appropriate when transarterial techniques or other attempts at transvenous access have failed due to vessel tortuosity, hypoplasia, stenosis, or occlusion. A middle-aged female patient presented with progressive left exophthalmos with conjunctiva chemosis and bruit after sustaining a falling injury. Digital subtraction angiography revealed Barrow type A carotid-cavernous fistula. The drainage route passed through a distal thrombosed superior ophthalmic vein that ended deep in the orbit. No other patent venous sinuses connected to the cavernous sinus, except for a small tract of pterygoid plexus. After failure of transarterial approach and other methods of transvenous access, we attempted to superselectly access to the cavernous sinus by applying transpterygoid technique with embolization using detachable coils. The transpterygoid venous approach to accessing the cavernous sinus represents an alternative approach when other techniques fail.
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spelling pubmed-81208542021-05-20 Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach Ou, Chang-Hsien Chen, Te-Yuan Lin, Pei-Ling Lee, Cheng-Lung Lin, Wan-Ching Radiol Case Rep Case Report We present a transvenous embolization technique for a direct carotid-cavernous fistula through the pterygoid plexus to the cavernous sinus which only 2 cases have been previously reported in the English literature. This method is appropriate when transarterial techniques or other attempts at transvenous access have failed due to vessel tortuosity, hypoplasia, stenosis, or occlusion. A middle-aged female patient presented with progressive left exophthalmos with conjunctiva chemosis and bruit after sustaining a falling injury. Digital subtraction angiography revealed Barrow type A carotid-cavernous fistula. The drainage route passed through a distal thrombosed superior ophthalmic vein that ended deep in the orbit. No other patent venous sinuses connected to the cavernous sinus, except for a small tract of pterygoid plexus. After failure of transarterial approach and other methods of transvenous access, we attempted to superselectly access to the cavernous sinus by applying transpterygoid technique with embolization using detachable coils. The transpterygoid venous approach to accessing the cavernous sinus represents an alternative approach when other techniques fail. Elsevier 2021-05-07 /pmc/articles/PMC8120854/ /pubmed/34025891 http://dx.doi.org/10.1016/j.radcr.2021.04.036 Text en © 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Ou, Chang-Hsien
Chen, Te-Yuan
Lin, Pei-Ling
Lee, Cheng-Lung
Lin, Wan-Ching
Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach
title Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach
title_full Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach
title_fullStr Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach
title_full_unstemmed Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach
title_short Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach
title_sort transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120854/
https://www.ncbi.nlm.nih.gov/pubmed/34025891
http://dx.doi.org/10.1016/j.radcr.2021.04.036
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