%0 Journal Article
%T Transvenous Aneurysm Sac and Rupture Point Coil Embolization of Direct Carotid Cavernous Fistula after Pipeline Embolization
%A Hajime Arai
%A Hidenori Oishi
%A Kenji Yatomi
%A Kosuke Teranishi
%A Munetaka Yamamoto
%J Archive of "NMC Case Report Journal".
%D 2018
%R 10.2176/nmccrj.cr.2017-0102
%X A delayed aneurysm rupture after flow diverter therapy is a rare but serious complication. Due to the anatomical specificity, a delayed rupture of a carotid cavernous aneurysm may cause a direct carotid cavernous fistula (dCCF). We present a novel therapeutic approach for treatment of dCCF after flow diverter therapy using the Pipeline embolization device (PED). An 86-year-old woman suffered from dCCF after PED embolization. A microcatheter was advanced through the transvenous approach into the cavernous sinus (CS) and further inserted into the aneurysm sac via the rupture point. Coil embolization of both the aneurysm sac and a small part of the CS adjacent to the fistulous site could achieve not only the immediate aneurysm occlusion but also the rupture point obliteration with a small amount of coil mass in the CS
%K transvenous coil embolization
%K flow diverter
%K carotid cavernous fistula
%K delayed aneurysm rupture
%K pipeline embolization device
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767481/