title: Direct carotid-cavernous fistulas occurring during neurointerventional procedures.
abstract: This study shows the frequency and types of carotid-cavernous fistula (CCF) complications that occurred during endovascular treatment. Transarterial endovascular surgeries involving the anterior circulation were performed for 1071 cases at our hospitals during four years. CCFs occurred in nine of 1071 cases (0.8%). CCF risk factors were female sex (p=0.032), aneurysmal location in the paraclinoid portion (p<0.001), and use of a distal access catheter (DAC) (p<0.001). There were no significant correlations between CCF risk and procedure type (p=0.411-1.0) and balloon use or nonuse (p=0.492). Eighty-nine percent (eight of nine) of the CCFs occurred at the genu of a cavernous internal carotid artery (ICA). Two cases of CCF disappeared spontaneously. The shunt was decreased by balloon expansion in one case, no additional treatment was required in one case, and five cases required transarterial fistula coil embolization. It is necessary to remember that a CCF may occur especially in aneurysmal treatment using a DAC in a female patient. The DAC and the 0.035-inch guidewire should be kept proximal to the carotid siphon and not go beyond it. When we cannot avoid navigating beyond it, we should consider using a softer DAC. In the case of a CCF caused by a DAC, it may be cured spontaneously or is treatable by transarterial coil embolization.
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Japan Onokeen@aol.com.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Ono
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Oishi
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tanoue
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Japan.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Arai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D017678:Sex Distribution
keywords: Carotid-cavernous fistula; catheter intervention; complication; distal access catheter