Transarterial platinum coil embolization of carotid-cavernous fistulas

V. V. Halbach, R. T. Higashida, S. L. Barnwell, C. F. Dowd, G. B. Hieshima

Research output: Contribution to journalArticle

98 Scopus citations

Abstract

Of the 227 embolization procedures performed by our neurointerventional section for symptomatic carotid-cavernous fistulas over the past 10 years, five involved placement of platinum coils in the cavernous sinus from a transarterial route. In four patients, prior transarterial balloon procedures had failed to produce fistula closure. In the fifth patient, with Ehlers-Danlos syndrome, a prior transvenous embolization attempt was unsuccessful. In three patients, complete closure of the carotid-cavernous fistula was achieved with preservation of the parent artery. In one patient, the earliest treated, a portion of a platinum coil projected through the fistula into the parent artery. To eliminate the risk of clot formation and distal embolization, internal carotid occlusion was performed and tolerated without deficits. In the last patient, closure of the anterior drainage was achieved, but complicated by distal migration of the platinum coils with transient aggravation of ocular symptoms. Attempts to occlude the remaining cortical drainage were unsuccessful with platinum coils; therefore, a balloon was used to obliterate the small remaining fistula. Transarterial platinum coil embolization is an alternative treatment for symptomatic carotid-cavernous fistulas that cannot be closed successfully by other embolization techniques. The development of shorter, more thrombogenic, detachable or retrievable coils may make this technique more promising in the future.

Original languageEnglish (US)
Pages (from-to)429-433
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume12
Issue number3
StatePublished - Jan 1 1991

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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    Halbach, V. V., Higashida, R. T., Barnwell, S. L., Dowd, C. F., & Hieshima, G. B. (1991). Transarterial platinum coil embolization of carotid-cavernous fistulas. American Journal of Neuroradiology, 12(3), 429-433.