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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
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Direct carotid-cavernous fistulas occurring during neurointerventional procedures
Kenichiro Ono1, Hidenori Oishi2, Shunsuke Tanoue2
1Department of Neurosurgery, Juntendo University School of Medicine, Japan Onokeen@aol.com.
Summary
Carotid-cavernous fistula (CCF) complications are rare during endovascular treatment. Female patients undergoing aneurysm treatment with a distal access catheter (DAC) face a higher CCF risk, often treatable with coil embolization.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Endovascular treatment is a common approach for cerebrovascular diseases.
- Carotid-cavernous fistula (CCF) is a potential complication during these procedures.
- Understanding CCF incidence and risk factors is crucial for patient safety.
Observation:
- A retrospective study analyzed 1071 endovascular surgeries for anterior circulation conditions.
- Nine cases (0.8%) of CCF were identified.
- CCFs predominantly occurred at the genu of the cavernous internal carotid artery (ICA).
Findings:
- Risk factors for CCF included female sex, paraclinoid aneurysms, and distal access catheter (DAC) use.
- No significant correlation was found with procedure type or balloon use.
- Spontaneous resolution occurred in two cases; others required intervention like coil embolization.
Implications:
- Awareness of CCF risk is vital, particularly in female patients undergoing aneurysm treatment with DACs.
- Guidewire and DAC navigation should remain proximal to the carotid siphon.
- Softer DACs may be considered when navigating beyond the siphon to mitigate CCF risk.
