Use of Pipeline Embolization Devices for treatment of a direct carotid-cavernous fistula.
Acta Neurochir (Wien)
; 157(7): 1125-9; discussion 1130, 2015 Jul.
Article
en En
| MEDLINE
| ID: mdl-25981434
ABSTRACT
BACKGROUND:
The use of minimally porous endoluminal devices (MPEDs) such as the Pipeline Embolization Device (PED) has been described for the treatment of brain aneurysms. The benefit of using MPEDs to assist embolization of a direct high-flow carotid cavernous fistula resulting from a ruptured cavernous carotid artery aneurysm is not well documented.METHODS:
We describe our experience with deploying a tailored multidevice PED construct across the cavernous internal carotid artery (ICA) wall defect in combination with transarterial coil embolization using the "jailed microcatheter" technique.RESULTS:
A 59-year-old woman presented with acute left-sided ophthalmoplegia. Diagnostic cerebral angiography demonstrated a ruptured giant cavernous carotid aneurysm with fistulous outflow via the ipsilateral left superior ophthalmic vein and into the pterygoid venous plexi bilaterally. Via the Marksman microcatheter, a total of three PEDs measuring 4.5 mm × 18 mm, 4.5 mm × 20 mm, and 4.75 mm × 16 mm were telescoped within the ICA across the aneurysm neck. Coiling of the aneurysm fundus and cavernous sinus via the "jailed" Rapidtransit microcatheter was subsequently achieved. A 2-year follow-up digital subtraction angiography (DSA) demonstrated stable obliteration of the aneurysm and the fistula, coincident with complete resolution of the patient's symptoms.CONCLUSIONS:
Based on our long-term clinical and angiographic results, we advocate that the presented method be a valid treatment option for selected cases.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Prótesis Vascular
/
Fístula del Seno Cavernoso de la Carótida
/
Embolización Terapéutica
/
Dispositivos de Acceso Vascular
Tipo de estudio:
Etiology_studies
Límite:
Female
/
Humans
/
Middle aged
Idioma:
En
Revista:
Acta Neurochir (Wien)
Año:
2015
Tipo del documento:
Article
País de afiliación:
Estados Unidos