Trans-arterial embolisation therapy of dural carotid–cavernous fistulae using low concentration n-butyl-cyanoacrylate |
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Authors: | Ming-Hua Li Hua-Qiao Tan Chun Fang Yue-Qi Zhu Wu Wang Jue Wang and Ying-Sheng Cheng |
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Institution: | (1) Department of Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, 600, Yi Shan Road, Shanghai, 200233, China |
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Abstract: | Background Trans-venous embolisation has been accepted as the preferred treatment for dural carotid–cavernous fistulae (DCCF). However,
such an approach is not always feasible. In this circumstance, trans-arterial embolisation with low concentration n-butyl-cyanoacrylate glue (NBCA) may be a feasible alternative. We report our results and experience of this method for DCCF.
Materials and methods Five patients with DCCF were treated by trans-arterial embolisation using low concentration NBCA by wedging the microcatheter
into the main feeding artery. All five lesions were associated with venous drainage into the superior ophthalmic vein. The
inferior petrosal sinus was patent in one patient and thrombosed in four. Additional venous drainage into the Sylvian vein
and the superior petrosal sinus was observed in two patients.
Findings The definitive NBCA injection was performed via the branches of the middle meningeal artery in three patients and accessory
meningeal artery as well as ascending pharyngeal artery in two patients. Four patients showed complete obliteration of the
DCCF on the post-embolisation angiogram, and follow-up studies showed clinical cure or improvement and successful obliteration
of the DCCF. One patient had a residual DCCF after the procedure, but showed complete obliteration and clinical cure at 5-month
follow-up. Glue penetrated into the Sylvian vein in one patient during the procedure without sequelae. Two patients had transient
worsening of ocular symptoms after the procedure.
Conclusions Trans-arterial embolisation with low concentration NBCA using a wedged microcatheter technique is still a safe and effective
treatment for DCCF when the transvenous approach is not feasible. However, care must be taken to prevent inadvertent arterial
and venous embolisation.
An erratum to this article can be found at |
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Keywords: | DCCF Trans-arterial embolisation n-Butyl-cyanoacrylate Glue |
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