High-Flow Carotid Cavernous Fistula and the Use of a Microvascular Plug System: Initial Experience

Yamin Shwe; Srinivasan Paramasivam; Santiago Ortega-Gutierrez; David Altschul; Alejandro Berenstein; Johanna T Fifi

doi:10.1159/000369477

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High-Flow Carotid Cavernous Fistula and the Use of a Microvascular Plug System: Initial Experience

Journal article

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High-Flow Carotid Cavernous Fistula and the Use of a Microvascular Plug System: Initial Experience

Yamin Shwe, Srinivasan Paramasivam, Santiago Ortega-Gutierrez, David Altschul, Alejandro Berenstein and Johanna T Fifi

Interventional neurology, Vol.3(2), pp.78-84

03/2015

DOI: 10.1159/000369477

PMCID: PMC4439797

PMID: 26019711

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Abstract

Purpose: We report our initial experience using a detachable microvascular plug system to occlude the internal carotid artery during endovascular treatment of high-flow carotid cavernous fistula. Case and Technique: An 87-year-old patient was admitted for acute-onset double vision with associated right-eye ptosis. Exam revealed a pupil-sparing, partial right third cranial nerve palsy. MRI showed a carotid cavernous fistula with high-flow drainage. Digital subtraction angiography showed a high-flow, right-sided, direct carotid cavernous fistula with flow from the proximal right internal carotid artery. The ophthalmic artery, posterior communicating artery and anterior communicating arteries supplied retrograde flow to the fistula through the internal carotid artery. Obliteration of the fistula was achieved through coil embolization in combination with proximal and distal microvascular plugs (Reverse Medical, Irvine, Calif., USA). Conclusion: The microvascular plug is a new addition to current endovascular embolization devices for the treatment of high-flow, direct carotid cavernous fistulas. This technique offers easy navigability through tortuous arteries, precise localization and immediate occlusion, which may allow shorter procedure and fluoroscopy times and increased cost-effectiveness. Larger case series are needed to support our observation.

Original Paper

Microvascular plug

High flow

Carotid cavernous fistula

Details

Title: Subtitle: High-Flow Carotid Cavernous Fistula and the Use of a Microvascular Plug System: Initial Experience
Creators: Yamin Shwe - Department of Neurology at Mount Sinai Beth Israel Medical Center, New York, N.Y., USA
Srinivasan Paramasivam - Hyman-Newman Institute of Neurology and Neurosurgery, Mount Sinai Hospital, New York, N.Y., USA
Santiago Ortega-Gutierrez - Hyman-Newman Institute of Neurology and Neurosurgery, Mount Sinai Hospital, New York, N.Y., USA
David Altschul - Hyman-Newman Institute of Neurology and Neurosurgery, Mount Sinai Hospital, New York, N.Y., USA
Alejandro Berenstein - Hyman-Newman Institute of Neurology and Neurosurgery, Mount Sinai Hospital, New York, N.Y., USA
Johanna T Fifi - Hyman-Newman Institute of Neurology and Neurosurgery, Mount Sinai Hospital, New York, N.Y., USA
Resource Type: Journal article
Publication Details: Interventional neurology, Vol.3(2), pp.78-84
DOI: 10.1159/000369477
PMID: 26019711
PMCID: PMC4439797
NLM abbreviation: Interv Neurol
ISSN: 1664-9737
eISSN: 1664-5545
Publisher: S. Karger AG
Language: English
Date published: 03/2015
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020642802771

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