Carotid cavernous fistula (CCF) treatment approaches: A systematic literature review and meta-analysis of transarterial and transvenous embolization for direct and indirect CCFs

Texakalidis, Pavlos; Tzoumas, Andreas; Xenos, Dimitrios; Rivet, Dennis J.; Reavey‐Cantwell, John

doi:10.1016/j.clineuro.2021.106601

Cited by 27 publications

(41 citation statements)

References 65 publications

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“…As a result, the mainstay of treatment for CCFs consists of transarterial or transvenous embolization. Furthermore, the endovascular approach has evolved as the first-line treatment option in clinical emergencies and following failure of conservative therapy [ 5 , 6 ]; however, other treatment options, such as open surgery or stereotactic radiosurgery are available as second-line or adjuvant therapeutic options [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Radiation Exposure During Diagnostic and Therapeutic Angiography of Carotid-cavernous Fistula

et al. 2021

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Purpose The aim of this study was to determine local diagnostic reference levels (DRLs) during endovascular diagnostics and therapy of carotid-cavernous fistulas (CCF). Methods In a retrospective study design, DRLs, achievable dose (AD) and mean values were assessed for all patients with CCF undergoing diagnostic angiography (I) or embolization (II). All procedures were performed with the flat-panel angiography system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the type of CCF and the type of procedure. Results In total, 86 neurointerventional procedures of 48 patients with CCF were executed between February 2010 and July 2021. The following DRLs, AD and mean values could be determined: (I) DRL 215 Gy ∙ cm2, AD 169 Gy ∙ cm2, mean 165 Gy ∙ cm2; (II) DRL 350 Gy ∙ cm2, AD 226 Gy ∙ cm2, mean 266 Gy ∙ cm2. Dose levels of embolization were significantly higher compared to diagnostic angiography (p < 0.001). No significant dose difference was observed with respect to the type of fistula or the embolization method. Conclusion This article reports on diagnostic and therapeutic DRLs in the management of CCF that could serve as a benchmark for the national radiation protection authorities. Differentiation by fistula type or embolization method does not seem to be useful.

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Section: Introductionmentioning

confidence: 99%

Radiation Exposure During Diagnostic and Therapeutic Angiography of Carotid-cavernous Fistula

et al. 2021

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“…Fifty-seven studies comprising 1,575 patients were identified, of which 31 reported embolization through the transarterial route, and the remaining 26 reported outcomes after a transvenous embolization approach. 32 Pooled data revealed complete obliteration in 425 (86%) of 494 cases of indirect CCFs treated with transvenous embolization technique. 32 Importantly, embolization using a liquid embolic agent (NBCA, Onyx, glue, or polyvinyl alcohol) resulted in a slightly lower complete obliteration rate than transvenous coil embolization (83.3% vs. 87.5%).…”

Section: Discussionmentioning

confidence: 95%

“… 32 Pooled data revealed complete obliteration in 425 (86%) of 494 cases of indirect CCFs treated with transvenous embolization technique. 32 Importantly, embolization using a liquid embolic agent (NBCA, Onyx, glue, or polyvinyl alcohol) resulted in a slightly lower complete obliteration rate than transvenous coil embolization (83.3% vs. 87.5%). 32 Interestingly, a subgroup of patients with a direct CCF underwent embolization transvenously, and an obliteration rate of 91.7% (33 of 36) was achieved.…”

Section: Discussionmentioning

confidence: 95%

“… 32 Importantly, embolization using a liquid embolic agent (NBCA, Onyx, glue, or polyvinyl alcohol) resulted in a slightly lower complete obliteration rate than transvenous coil embolization (83.3% vs. 87.5%). 32 Interestingly, a subgroup of patients with a direct CCF underwent embolization transvenously, and an obliteration rate of 91.7% (33 of 36) was achieved. 32 In addition, pooled obliteration rates were similar among the 5 studies directly comparing transvenous versus transarterial embolizations for indirect fistulas (odds ratio 0.62, 95% confidence interval 0.31–1.23, I 2 = 0.0%).…”

Section: Discussionmentioning

confidence: 97%

“…Permanent symptomatic complications were reported in only 0.5% of cases. 31 Similarly, in a systematic review recently published by Texakalidis et al, 32 a direct comparison between transvenous and transarterial approaches for both direct and indirect CCFs was conducted. Fifty-seven studies comprising 1,575 patients were identified, of which 31 reported embolization through the transarterial route, and the remaining 26 reported outcomes after a transvenous embolization approach.…”

Section: Discussionmentioning

confidence: 99%

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First reported single-surgeon transpalpebral hybrid approach for indirect cavernous carotid fistula: illustrative case

Cappuzzo

Baig

Metcalf-Doetsch

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Failure to reach the cavernous sinus after multiple transvenous attempts, although rare, can be challenging for neurointerventionists. The authors sought to demonstrate technical considerations and nuances of the independent performance of a novel hybrid surgical and endovascular transpalpebral approach through the superior ophthalmic vein (SOV) for direct coil embolization of an indirect carotid cavernous fistula (CCF), and they review salient literature regarding the transpalpebral approach. OBSERVATIONS An illustrative case, including patient history and presentation, was reviewed. PubMed, MEDLINE, and Embase databases were searched for articles published between January 1, 2000, and September 30, 2021, that reported ≥1 patient with a CCF treated endovascularly via the SOV approach. Data extracted included sample size, treatment modality, surgical technique, performing surgeon specialty, and procedure outcome. The authors’ case illustration demonstrates the technique for the hybrid transpalpebral approach. For the review, 273 unique articles were identified; 14 containing 74 treated patients fulfilled the inclusion criteria. Oculoplastic surgery was the most commonly involved specialty (5 of 14 studies), followed by ophthalmology (3 of 14). Coiling alone was the treatment of choice in 12 studies, with adjunctive use of Onyx (Medtronic) in 2. LESSONS The authors’ technical case description, video, illustrations, and review provide endovascular neurosurgeons with a systematic guide to conduct the procedure independently.

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Red Eye and Choroidal Detachment in an Older Woman

2023

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Carotid cavernous fistula (CCF) treatment approaches: A systematic literature review and meta-analysis of transarterial and transvenous embolization for direct and indirect CCFs

Cited by 27 publications

References 65 publications

Radiation Exposure During Diagnostic and Therapeutic Angiography of Carotid-cavernous Fistula

Radiation Exposure During Diagnostic and Therapeutic Angiography of Carotid-cavernous Fistula

First reported single-surgeon transpalpebral hybrid approach for indirect cavernous carotid fistula: illustrative case

Red Eye and Choroidal Detachment in an Older Woman

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