Carotid‐cavernous fistula after endovascular intervention for chronic carotid artery total occlusion

摘要

Abstract Background and Purpose In addition to head trauma and cranial surgery, endovascular intervention for chronic carotid artery occlusion (CAO) may also result in carotid‐cavernous fistula (CCF). The management and prognosis of iatrogenic CCF during CAO recanalization have never been well described and discussed in the literature. Materials and Methods We conducted a retrospective analysis for CAO recanalization attempts in National Taiwan University Hospital and affiliated hospitals. Incidence and presentation, demographic and angiographic variables, and clinical follow‐up of the development of iatrogenic CCF were carefully reviewed. Results A total of 138 consecutive de novo CAO endovascular recanalization attempts were reviewed. The technical success rate was 61.6% (85/138). Complication rate, including death, stroke, and intracranial or sub‐arachnoid hemorrhage (ICH or SAH) was 4.3% (6/138). CCF developed in 11 patients (8.0%), and none resulted in death, stroke, or ICH/SAH within 30 days. Female gender and distal carotid artery reconstitution at communicating or ophthalmic segments were associated with development of CCF. Imaging follow‐ups were performed in eight patients and none showed persistent CCF. Conclusion CCF may develop during chronic CAO endovascular recanalization attempts. It is usually self‐limited and can be managed conservatively.