Carotid Cavernous Fistula during Thrombectomy for Acute Ischemic Stroke: A Case Report
Objective: We report a rare complication, carotid cavernous fistula (CCF), due to vessel perforation during thrombectomy for acute ischemic stroke (AIS).Case Presentation: An 88-year-old woman underwent thrombectomy for left C4 occlusion of the internal carotid artery. There was strong resistance at...
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| Published in | Journal of Neuroendovascular Therapy Vol. 15; no. 7; pp. 438 - 443 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
The Japanese Society for Neuroendovascular Therapy
2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1882-4072 2186-2494 |
| DOI | 10.5797/jnet.cr.2020-0089 |
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| Abstract | Objective: We report a rare complication, carotid cavernous fistula (CCF), due to vessel perforation during thrombectomy for acute ischemic stroke (AIS).Case Presentation: An 88-year-old woman underwent thrombectomy for left C4 occlusion of the internal carotid artery. There was strong resistance at the medial C4 while the microguidewire was guided distally, and a CCF was found after deploying and retrieving the stent. It was thought to have been caused by perforation due to intracranial atherosclerotic stenosis of the internal carotid artery.Conclusion: During thrombectomy for intracranial large vessel occlusion underlying intracranial atherosclerotic stenosis, the risk of vascular injury should be kept in mind. |
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| AbstractList | Objective: We report a rare complication, carotid cavernous fistula (CCF), due to vessel perforation during thrombectomy for acute ischemic stroke (AIS).Case Presentation: An 88-year-old woman underwent thrombectomy for left C4 occlusion of the internal carotid artery. There was strong resistance at the medial C4 while the microguidewire was guided distally, and a CCF was found after deploying and retrieving the stent. It was thought to have been caused by perforation due to intracranial atherosclerotic stenosis of the internal carotid artery.Conclusion: During thrombectomy for intracranial large vessel occlusion underlying intracranial atherosclerotic stenosis, the risk of vascular injury should be kept in mind. We report a rare complication, carotid cavernous fistula (CCF), due to vessel perforation during thrombectomy for acute ischemic stroke (AIS). An 88-year-old woman underwent thrombectomy for left C4 occlusion of the internal carotid artery. There was strong resistance at the medial C4 while the microguidewire was guided distally, and a CCF was found after deploying and retrieving the stent. It was thought to have been caused by perforation due to intracranial atherosclerotic stenosis of the internal carotid artery. During thrombectomy for intracranial large vessel occlusion underlying intracranial atherosclerotic stenosis, the risk of vascular injury should be kept in mind. |
| ArticleNumber | cr.2020-0089 |
| Author | Tsuji, Atsushi Tsuji, Keiichi Nozaki, Kazuhiko Ogawa, Nobuhiro Yoshimura, Yayoi Nakazawa, Takuya |
| Author_xml | – sequence: 1 fullname: Ogawa, Nobuhiro organization: Department of Neurology, Shiga University of Medical Science, Otsu, Shiga, Japan – sequence: 1 fullname: Nozaki, Kazuhiko organization: Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan – sequence: 1 fullname: Tsuji, Keiichi organization: Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan – sequence: 1 fullname: Tsuji, Atsushi organization: Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan – sequence: 1 fullname: Yoshimura, Yayoi organization: Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan – sequence: 1 fullname: Nakazawa, Takuya organization: Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan |
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| Cites_doi | 10.1056/NEJMoa1503780 10.3171/2014.4.JNS132187 10.1002/jmri.1880060505 10.1016/j.wneu.2017.01.112 10.1097/00004728-200607000-00012 10.5797/jnet.cr.2018-0144 10.1001/jama.2016.12266 10.1136/neurintsurg-2016-012707 10.1136/neurintsurg-2017-013489 10.1056/NEJMx140064 10.5797/jnet.cr.2017-0089 10.1136/neurintsurg-2018-014060 10.5797/jnet.tn.2016-0069 10.1177/159101990601200106 10.1056/NEJMoa1415061 10.5797/jnet.tn.2016-0073 |
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| Copyright | 2021 The Japanese Society for Neuroendovascular Therapy 2021 The Japanese Society for Neuroendovascular Therapy. 2021 The Japanese Society for Neuroendovascular Therapy 2021 |
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| Keywords | carotid cavernous fistula acute cerebral infarction thrombectomy vessel perforation |
| Language | English |
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| References | 4) Jovin TG, Chamorro A, Cobo E, et al: Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296–2306. 9) Leischner H, Flottmann F, Hanning U, et al: Reasons for failed endovascular recanalization attempts in stroke patients. J Neurointerv Surg 2019; 11: 439–442. 6) Mokin M, Fargen KM, Primiani CT, et al: Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes. J Neurointerv Surg 2017; 9: 922–928. 18) Nakamura A, Kawashima A, Hayashi M, et al: Internal carotid artery injury due to aspiration technique from balloon guide catheter on acute thrombectomy: a case report. JNET J Neuroendovasc Ther 2019; 13: 354–357. 10) Jia B, Feng L, Liebeskind DS, et al: Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis. J Neurointerv Surg 2018; 10: 746–750. 5) Saver JL, Goyal M, Bonafe A, et al: Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295. 15) Ohshima T, Imai T, Sato M, et al: A novel technique for higher success rates of recanalization with stent clot retriever: corkscrew penetrating method. JNET J Neuroendovasc Ther 2017; 11: 94–98. 16) Leishangthem L, Satti SR: Vessel perforation during withdrawal of Trevo ProVue stent retriever during mechanical thrombectomy for acute ischemic stroke. J Neurosurg 2014; 121: 995–998. 17) Layton KF, Cloft HJ, Kallmes DF: Cerebral aneurysm perforations during treatment with detachable coils. Use of remodelling balloon inflation to achieve hemostasis. Interv Neuroradiol 2006; 12: 31–35. 11) Saver JL, Goyal M, van der Lugt A, et al: Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016; 316: 1279–1288. 14) Sato M, Ohshima T, Ishikawa K, et al: A novel technique of safe and versatile microguidewire shaping with neuroendovascular therapy: modified pigtail method. JNET J Neuroendovasc Ther 2017; 11: 266–271. 7) Matsumoto H, Nishiyama H, Takemoto H, et al: Carotid-cavernous fistula caused by vessel injury while withdrawing a stent retriever during mechanical thrombectomy for acute ischemic stroke: a case report. JNET J Neuroendovasc Ther 2018; 12: 235–240. 8) Alan N, Nwachuku E, Jovin TJ, et al: Management of iatrogenic direct carotid cavernous fistula occurring during endovascular treatment of stroke. World Neurosurg 2017; 100: 710.e15–710.e20. 13) Taoka T, Iwasaki S, Nakagawa H, et al: Evaluation of arteriosclerotic changes in the intracranial carotid artery using the calcium score obtained on plain cranial computed tomography scan: Correlation with angiographic changes and clinical outcome. J Comput Assist Tomogr 2006; 30: 624–628. 12) Wildy KS, Yuan C, Tsuruda JS, et al: Atherosclerosis of the carotid artery: evaluation by magnetic resonance angiography. J Magn Reson Imaging 1996; 6: 726–732. 3) Campbell BC, Mitchell PJ, Kleinig TJ, et al: Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018. 1) Goyal M, Demchuk AM, Menon BK, et al: Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030. 2) Berkhemer OA, Fransen PS, Beumer D, et al: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20. 11 12 13 14 15 16 17 18 1 2 3 4 5 6 7 8 9 10 |
| References_xml | – reference: 9) Leischner H, Flottmann F, Hanning U, et al: Reasons for failed endovascular recanalization attempts in stroke patients. J Neurointerv Surg 2019; 11: 439–442. – reference: 11) Saver JL, Goyal M, van der Lugt A, et al: Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016; 316: 1279–1288. – reference: 3) Campbell BC, Mitchell PJ, Kleinig TJ, et al: Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018. – reference: 4) Jovin TG, Chamorro A, Cobo E, et al: Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296–2306. – reference: 2) Berkhemer OA, Fransen PS, Beumer D, et al: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20. – reference: 7) Matsumoto H, Nishiyama H, Takemoto H, et al: Carotid-cavernous fistula caused by vessel injury while withdrawing a stent retriever during mechanical thrombectomy for acute ischemic stroke: a case report. JNET J Neuroendovasc Ther 2018; 12: 235–240. – reference: 5) Saver JL, Goyal M, Bonafe A, et al: Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295. – reference: 8) Alan N, Nwachuku E, Jovin TJ, et al: Management of iatrogenic direct carotid cavernous fistula occurring during endovascular treatment of stroke. World Neurosurg 2017; 100: 710.e15–710.e20. – reference: 10) Jia B, Feng L, Liebeskind DS, et al: Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis. J Neurointerv Surg 2018; 10: 746–750. – reference: 18) Nakamura A, Kawashima A, Hayashi M, et al: Internal carotid artery injury due to aspiration technique from balloon guide catheter on acute thrombectomy: a case report. JNET J Neuroendovasc Ther 2019; 13: 354–357. – reference: 12) Wildy KS, Yuan C, Tsuruda JS, et al: Atherosclerosis of the carotid artery: evaluation by magnetic resonance angiography. J Magn Reson Imaging 1996; 6: 726–732. – reference: 14) Sato M, Ohshima T, Ishikawa K, et al: A novel technique of safe and versatile microguidewire shaping with neuroendovascular therapy: modified pigtail method. JNET J Neuroendovasc Ther 2017; 11: 266–271. – reference: 17) Layton KF, Cloft HJ, Kallmes DF: Cerebral aneurysm perforations during treatment with detachable coils. Use of remodelling balloon inflation to achieve hemostasis. Interv Neuroradiol 2006; 12: 31–35. – reference: 1) Goyal M, Demchuk AM, Menon BK, et al: Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030. – reference: 6) Mokin M, Fargen KM, Primiani CT, et al: Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes. J Neurointerv Surg 2017; 9: 922–928. – reference: 13) Taoka T, Iwasaki S, Nakagawa H, et al: Evaluation of arteriosclerotic changes in the intracranial carotid artery using the calcium score obtained on plain cranial computed tomography scan: Correlation with angiographic changes and clinical outcome. J Comput Assist Tomogr 2006; 30: 624–628. – reference: 15) Ohshima T, Imai T, Sato M, et al: A novel technique for higher success rates of recanalization with stent clot retriever: corkscrew penetrating method. JNET J Neuroendovasc Ther 2017; 11: 94–98. – reference: 16) Leishangthem L, Satti SR: Vessel perforation during withdrawal of Trevo ProVue stent retriever during mechanical thrombectomy for acute ischemic stroke. J Neurosurg 2014; 121: 995–998. – ident: 4 doi: 10.1056/NEJMoa1503780 – ident: 3 – ident: 16 doi: 10.3171/2014.4.JNS132187 – ident: 12 doi: 10.1002/jmri.1880060505 – ident: 8 doi: 10.1016/j.wneu.2017.01.112 – ident: 1 – ident: 13 doi: 10.1097/00004728-200607000-00012 – ident: 18 doi: 10.5797/jnet.cr.2018-0144 – ident: 11 doi: 10.1001/jama.2016.12266 – ident: 6 doi: 10.1136/neurintsurg-2016-012707 – ident: 10 doi: 10.1136/neurintsurg-2017-013489 – ident: 2 doi: 10.1056/NEJMx140064 – ident: 7 doi: 10.5797/jnet.cr.2017-0089 – ident: 9 doi: 10.1136/neurintsurg-2018-014060 – ident: 15 doi: 10.5797/jnet.tn.2016-0069 – ident: 17 doi: 10.1177/159101990601200106 – ident: 5 doi: 10.1056/NEJMoa1415061 – ident: 14 doi: 10.5797/jnet.tn.2016-0073 |
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| Snippet | Objective: We report a rare complication, carotid cavernous fistula (CCF), due to vessel perforation during thrombectomy for acute ischemic stroke (AIS).Case... Objective: We report a rare complication, carotid cavernous fistula (CCF), due to vessel perforation during thrombectomy for acute ischemic stroke (AIS). Case... We report a rare complication, carotid cavernous fistula (CCF), due to vessel perforation during thrombectomy for acute ischemic stroke (AIS). An 88-year-old... |
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| SubjectTerms | acute cerebral infarction carotid cavernous fistula Case Report thrombectomy vessel perforation |
| Title | Carotid Cavernous Fistula during Thrombectomy for Acute Ischemic Stroke: A Case Report |
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