Endovascular Management of Direct Carotid-Cavernous Fistula | ||
| The Egyptian Journal of Hospital Medicine | ||
| Article 69, Volume 100, Issue 1, July 2025, Pages 3010-3017 PDF (525.41 K) | ||
| DOI: 10.21608/ejhm.2025.441846 | ||
| Abstract | ||
| Background: Carotid-cavernous fistulas (CCF) are aberrant arteriovenous connection between the carotid artery system and the venous compartments of the cavernous sinus (CS). Endovascular techniques established themselves as the primary approach for treating direct CCFs, aiming principally to seal the fistula while maintaining the patency of the internal carotid artery (ICA).Objec tive: This study aimed to assess the safety and effectiveness of endovascular management in treating direct carotid-cavernous fistulas. Patients and methods: We prospectively collected data pertaining to 15 patients with direct type CCFs who underwent endovascular treatment using different techniques, including coiling, coiling and Onyx, detachable balloons, graft stenting and ICA sacrificing, at our institution department and other affiliated centers between June 2023 and January 2025 (10 males and 5 females with a mean age of 38.30 ± 11.88 years. The type of fistula, route of embolization, additional use of coils, technical success, inadvertent events, procedural complications, recurrence rate and clinical follow-up were recorded. Results: 14 patient (93.3%) presented with unilateral ecchymosis and proptosis while 1 (6.7.0%) patients presented with bilateral ecchymosis and proptosis. Regarding the approach used for embolization, 3 (20.0%) patients underwent trans-venous embolization (TVE), of which 1 underwent embolization through superior ophthalmic vein (6.3%), 1 (6.3%) patient underwent TVE through inferior petrosal sinus, and 1 (6.3.0%) patient underwent TVE through facial vein, 12 (80.0%) patients underwent trans-arterial embolization. Coils were used in 12 (80%) patients. Angiographic total occlusion was reported in all of patients in the present study with no incidence of recanalization. Conclusion: Endovascular approach in treating CCFs was safe and effective method in treatment of direct type CCF, whereas despite its efficacy and benefits, it is not without side effects. Therefore good selection of patients is needed and some technical tips and tricks should be respected. | ||
| Keywords | ||
| Carotid-cavernous fistulas; Cavernous sinus; Internal carotid artery | ||
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