Usage of Laminaria Embolization Procedure for the Treatment of Carotid-Cavernous Fistula: Case Report and Technical Note

Chu, Jeong Wha; Lee, Ki Chan; Lee, Hoon Kap; Rim, Chang Soo; Cha, In Ho

Abstract

Many different type of embolic material, such as muscles Gelfoam, porcelain, and detachable balloon, etc, has been used for the treatment of carotid-cavernous fistula. In an effort to achieve better results the authors used laminaria, a sea-weeds root, as a newly-tried embolus which has a unique characteristic of expanding gradually within 4 hours 3-4 times from its original width, but not in length, when in contact with any type of fluid. A very special feature of the laminaria is that the initial hard and coarserness is slowly transformed while expanding into a rounded softness as to allow no menhanical injury to the surrounding vessels of tissue. The laminaria was formed into a reversed bowling-pin shape measuring 8x1.5mm with tapered tail and a round head in which contains a sliver clip as a radiographic marker. An extension of standard angiographic technique ahs been used to complete an alternative method of treatment. This technique involves introducing the cather harboring the laminaria by the percutaneous route either transfemoral or directly transcarotid and releasing the terminal internal carotid artery at the site of the fistula. Releasing a few of the shaped laminaria piece from the catheter tip has resulted in a successful obliteration of the fistula in 7 cases out of total 8 of carotid-cavernous fistula.