title: Treatment of Barrow type 'B' carotid cavernous fistulas with flow diverter stent (Pipeline).
abstract: Background Carotid cavernous fistulas (CCFs) Barrow type 'B' are dural shunts between the meningeal branches of the internal carotid artery and the cavernous sinus. The symptoms include vision deterioration, ophthalmoplegia with diplopia, exophthalmos, conjunctival injection, chemosis, ocular bruit, seizures, or neurological deficit. Endovascular treatment remains the gold standard for treatment through the transvenous or transarterial routes. The transvenous approaches have been proved to be the first option. Endovascular access through the superior ophthalmic vein (SOV) or inferior petrosal sinus have been widely used. The problem arises when there is no vascular access. For these cases, different approaches have been described, such as: direct access to the SOV; combining direct access to the SOV along with blind probing of the proximal occluded SOV; and a direct puncture of the cavernous sinus. But these techniques are very aggressive and can cause serious complications. As a result of the above, we describe a new alternative technique, which is effective and less invasive for the treatment of these special cases. Case reports We report two cases of Barrow type 'B' CCFs that did not have vascular access (neither arterial nor venous) to embolise fistulas with coils or glue, and which were successfully resolved with a flow diverter (Pipeline) stent in the internal carotid artery. To our knowledge, this treatment has not previously been described for this pathology. Conclusions The placement of a flow diverter stent in the internal carotid artery is an effective alternative technique in those cases of Barrow type 'B' CCFs that have no vascular access (neither venous nor arterial).
authors.affiliation: 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Castaño
authors.affiliation: 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Remollo
authors.affiliation: 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: García-Sort
authors.affiliation: 2 Neurosurgery Department, Hospital Universitario Germans Trias i Pujol, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Domínguez
authors.affiliation: 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: Terceño
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D015607:Stents; D016896:Treatment Outcome
keywords: Carotid cavernous fistula; Pipeline; flow diverter; interventional neuroradiology