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Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication?
BACKGROUND: Flow diversion (FD) is an established treatment for large or giant wide-necked unruptured intracranial aneurysms. In the past few years, the use of flow diverter devices was extended to several other “off-label” indications, including solitary or adjunctive treatment to coil embolization...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Scientific Scholar
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9990788/ https://www.ncbi.nlm.nih.gov/pubmed/36895234 http://dx.doi.org/10.25259/SNI_1113_2022 |
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author | Brunasso, Lara Casamassima, Nicola Abrignani, Sergio Sturiale, Carmelo Lucio Incandela, Francesca Giammalva, Giuseppe Roberto Iacopino, Domenico Gerardo Maugeri, Rosario Craparo, Giuseppe |
author_facet | Brunasso, Lara Casamassima, Nicola Abrignani, Sergio Sturiale, Carmelo Lucio Incandela, Francesca Giammalva, Giuseppe Roberto Iacopino, Domenico Gerardo Maugeri, Rosario Craparo, Giuseppe |
author_sort | Brunasso, Lara |
collection | PubMed |
description | BACKGROUND: Flow diversion (FD) is an established treatment for large or giant wide-necked unruptured intracranial aneurysms. In the past few years, the use of flow diverter devices was extended to several other “off-label” indications, including solitary or adjunctive treatment to coil embolization for direct (Barrow A type) carotid cavernous fistulas (CCFs). The use of liquid embolic agents still represents the first-line treatment for indirect CCFs. Typically, the ipsilateral inferior petrosal sinus or superior ophthalmic vein (SOV) is the preferred transvenous routes to access CCFs. In some cases, vessel tortuosity or different features make the endovascular access challenging, thus requiring different approaches and strategies. The aim of the study is to discuss rational and technical aspect in treating indirect CCFs referring to the most up-to-date literature. An alternative experience-based endovascular strategy with FD is described. METHODS: We report the case of a 54-year-old woman diagnosed with indirect CCF and treated with flow diverter stent. RESULTS: After multiple unsuccessful attempts at transarterial right SOV catheterization, a right indirect CCF fed by a single trunk at the ophthalmic origin from the internal carotid artery (ICA) was treated by ICA stand-alone FD. Blood flow was redirect and successfully reduced through the fistula, with immediately postprocedure improvement of the patient’s clinical status (ipsilateral proptosis and chemosis). Ten-months radiological follow-up showed the complete obliteration of the fistula. No adjunctive endovascular treatment was performed. CONCLUSION: FD appears a reasonable alternative stand-alone endovascular strategy also for selected difficult-to-access indirect CCFs, when all conventional routes are judged unfeasible. Further investigations will be necessary to better define and support this potential lesson-learned application. |
format | Online Article Text |
id | pubmed-9990788 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Scientific Scholar |
record_format | MEDLINE/PubMed |
spelling | pubmed-99907882023-03-08 Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication? Brunasso, Lara Casamassima, Nicola Abrignani, Sergio Sturiale, Carmelo Lucio Incandela, Francesca Giammalva, Giuseppe Roberto Iacopino, Domenico Gerardo Maugeri, Rosario Craparo, Giuseppe Surg Neurol Int Technical Notes BACKGROUND: Flow diversion (FD) is an established treatment for large or giant wide-necked unruptured intracranial aneurysms. In the past few years, the use of flow diverter devices was extended to several other “off-label” indications, including solitary or adjunctive treatment to coil embolization for direct (Barrow A type) carotid cavernous fistulas (CCFs). The use of liquid embolic agents still represents the first-line treatment for indirect CCFs. Typically, the ipsilateral inferior petrosal sinus or superior ophthalmic vein (SOV) is the preferred transvenous routes to access CCFs. In some cases, vessel tortuosity or different features make the endovascular access challenging, thus requiring different approaches and strategies. The aim of the study is to discuss rational and technical aspect in treating indirect CCFs referring to the most up-to-date literature. An alternative experience-based endovascular strategy with FD is described. METHODS: We report the case of a 54-year-old woman diagnosed with indirect CCF and treated with flow diverter stent. RESULTS: After multiple unsuccessful attempts at transarterial right SOV catheterization, a right indirect CCF fed by a single trunk at the ophthalmic origin from the internal carotid artery (ICA) was treated by ICA stand-alone FD. Blood flow was redirect and successfully reduced through the fistula, with immediately postprocedure improvement of the patient’s clinical status (ipsilateral proptosis and chemosis). Ten-months radiological follow-up showed the complete obliteration of the fistula. No adjunctive endovascular treatment was performed. CONCLUSION: FD appears a reasonable alternative stand-alone endovascular strategy also for selected difficult-to-access indirect CCFs, when all conventional routes are judged unfeasible. Further investigations will be necessary to better define and support this potential lesson-learned application. Scientific Scholar 2023-02-24 /pmc/articles/PMC9990788/ /pubmed/36895234 http://dx.doi.org/10.25259/SNI_1113_2022 Text en Copyright: © 2023 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Technical Notes Brunasso, Lara Casamassima, Nicola Abrignani, Sergio Sturiale, Carmelo Lucio Incandela, Francesca Giammalva, Giuseppe Roberto Iacopino, Domenico Gerardo Maugeri, Rosario Craparo, Giuseppe Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication? |
title | Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication? |
title_full | Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication? |
title_fullStr | Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication? |
title_full_unstemmed | Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication? |
title_short | Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication? |
title_sort | flow diversion for indirect carotid-cavernous fistula: still an off-label indication? |
topic | Technical Notes |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9990788/ https://www.ncbi.nlm.nih.gov/pubmed/36895234 http://dx.doi.org/10.25259/SNI_1113_2022 |
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