Carotid-cavernous fistula after endovascular intervention for chronic carotid artery total occlusion.
BACKGROUND AND PURPOSE
In addition to head trauma and cranial surgery, endovascular intervention for chronic carotid artery occlusion (CAO) may also result in carotid-cavernous fistula (CCF). The management and prognosis of iatrogenic CCF during CAO recanalization have never been well described and discussed in the literature.


MATERIALS AND METHODS
We conducted a retrospective analysis for CAO recanalization attempts in National Taiwan University Hospital and affiliated hospitals. Incidence and presentation, demographic and angiographic variables, and clinical follow-up of the development of iatrogenic CCF were carefully reviewed.


RESULTS
A total of 138 consecutive de novo CAO endovascular recanalization attempts were reviewed. The technical success rate was 61.6% (85/138). Complication rate, including death, stroke, and intracranial or sub-arachnoid hemorrhage (ICH or SAH) was 4.3% (6/138). CCF developed in 11 patients (8.0%), and none resulted in death, stroke, or ICH/SAH within 30 days. Female gender and distal carotid artery reconstitution at communicating or ophthalmic segments were associated with development of CCF. Imaging follow-ups were performed in eight patients and none showed persistent CCF.


CONCLUSION
CCF may develop during chronic CAO endovascular recanalization attempts. It is usually self-limited and can be managed conservatively.
['Yeh|Chih-Fan|CF|', 'Chen|Yin-Hsien|YH|', 'Lin|Mao-Shin|MS|', 'Huang|Ching-Chang|CC|', 'Hung|Chi-Sheng|CS|', 'Meng|Shih-Wei|SW|', 'Lee|Chih-Kuo|CK|', 'Kao|Hsien-Li|HL|0000-0002-5278-3540']
D000368:Aged D000369:Aged, 80 and over D016893:Carotid Stenosis D020216:Carotid-Cavernous Sinus Fistula D002533:Cerebral Angiography D002908:Chronic Disease D000072700:Conservative Treatment D016208:Databases, Factual D057510:Endovascular Procedures D005260:Female D006801:Humans D007049:Iatrogenic Disease D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012307:Risk Factors D013624:Taiwan D016896:Treatment Outcome
carotid-cavernous fistula chronic carotid artery occlusion recanalization complication carotid endovascular intervention perfusion