Clinical improvement in indirect carotid cavernous fistulas treated endovascularly: A patient based review

Ak, Ayşın Kısabay; Çınar, Celal; Doğan, Gözde Nur; Ataç, Ceyla; Gökçay, Figen; Çelebisoy, Neşe

doi:10.1016/j.clineuro.2021.106750

Cited by 4 publications

(8 citation statements)

References 30 publications

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“…2 Accordingly, the transvenous method has become the first choice of approach to indirect CCFs. [2][3][4]10,13,14 In a systemic review and meta-analysis, Alexandre et al showed that transvenous embolization was the most common method of EVT for the treatment of indirect CCFs in the last two decades. 15 The transvenous technique has a high rate of immediate CCF obliteration (80%-90%).…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

Baharvahdat,

Qoorchi Moheb Seraj,

Al-Raaisi

et al. 2024

Neurosurgical Focus

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OBJECTIVE Endovascular treatment (EVT) is the primary approach used to treat indirect carotid-cavernous fistulas (CCFs). In this study, the authors evaluated the immediate and long-term efficacy and safety of different endovascular techniques for indirect CCFs. METHODS The databases of two endovascular centers were retrospectively reviewed to collect the patients with indirect CCFs treated using endovascular techniques between 2013 and 2023. Demographics, clinical presentation, CCF features, EVT characteristics, and clinical and radiological outcomes were evaluated and analyzed. The analysis was performed to compare the clinical and radiological data between different endovascular approaches and different embolic materials. RESULTS Ninety-eight patients were included in the study. EVT was successful in 95 patients (96.9%). Immediate complete obliteration of the CCF was achieved in 93.9% of patients, with 98% undergoing embolization with liquid embolic agents (LEAs) and 95.6% undergoing coiling alone. Complete CCF obliteration was higher in the transvenous than in the transarterial approach (94.3% vs 75%, p = 0.010). At ≥ 6 months follow-up, complete CCF obliteration was achieved in all patients (100%). The rate of procedure-related complications was higher following LEAs than with coiling alone (32.0% vs 15.6%). New cranial nerve (CN) palsy was diagnosed in 26.0% and 2.2% after embolization with LEAs and coiling alone, respectively (p = 0.001), with complete CN palsy recovery in 78.6%. Procedure-related intracranial hemorrhage occurred in 3 patients (3.1%). Two patients experienced an ischemic stroke following Onyx migration into the internal carotid artery. Ocular symptoms improved in 93% (83/89) of the patients who were followed. CONCLUSIONS In this study, complete obliteration of an indirect CCF was achieved in more than 90% of patients. Despite the occurrence of some new postprocedural ocular CN palsy, ocular symptoms improved in most patients in long-term follow-up. The transvenous approach was the most effective method for treating the indirect CCF. Coiling was safer than LEAs for the embolization of the indirect CCF.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

Baharvahdat,

Qoorchi Moheb Seraj,

Al-Raaisi

et al. 2024

Neurosurgical Focus

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“…Despite the high success rate of either transarterial- or transvenous embolization for CCFs, residual ocular symptoms occasionally occur. A patient based review demonstrated that these residual deficits included eye movement deficits, decreased visual acuity and persistent elevated IOP ( 5 , 14 ). However, ocular ischemic syndrome or even retinopathy were very rare ocular complications following CCFs treated by TAEs.…”

Section: Discussionmentioning

confidence: 99%

Serous retinal detachment secondary to an unsuccessful transarterial embolization in a post-traumatic carotid-cavernous sinus fistula patient: A case report

Lee

2022

Front. Med.

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A carotid-cavernous sinus fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. Direct CCFs arise from a direct connection between the cavernous sinus and the cavernous portion of the internal carotid artery. Nowadays, endovascular neurosurgery has become the first-line treatment modality for direct CCFs owing to the high complete obliteration rate. However, reversal of the clinical symptoms may not always be congruous after the endovascular intervention. Herein, we present a 50-year-old patient who manifested diplopia, ophthalmoplegia, and orbital congestion after a traffic accident. He had suffered head injury with right side frontal intracranial hemorrhage 1 month before the ophthalmic presentation. He came to our department primarily because of declining vision and for the above symptoms, and was diagnosed with direct type CCF, for which he received transarterial coil embolization. Unexpectedly, he later presented with serous retinal detachment accompanied by ocular ischemic syndrome secondary to recurrent CCF 1 month after the intervention, so repeat coil embolization was performed.

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“…The improvement of presentations is a focal point noticed by us in our report. Though progressive symptom in iatrogenic CCFs is not reported before, some studys still find that spontaneous dural CCFs are inclined to occur in middle-aged or elderly women [ 6 , 7 ]. Particularly the risk of incidence in postmenopausal women is 7 times higher than that in men [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Though progressive symptom in iatrogenic CCFs is not reported before, some studys still find that spontaneous dural CCFs are inclined to occur in middle-aged or elderly women [ 6 , 7 ]. Particularly the risk of incidence in postmenopausal women is 7 times higher than that in men [ 7 ]. Apart from sex and age, there are also certain risk factors including systemic hypertension, diabetes mellitus, atherosclerotic vascular disease, connective tissue disease and minor trauma [ [6] , [7] , [8] , [9] , [10] ].…”

Section: Discussionmentioning

confidence: 99%

“…Particularly the risk of incidence in postmenopausal women is 7 times higher than that in men [ 7 ]. Apart from sex and age, there are also certain risk factors including systemic hypertension, diabetes mellitus, atherosclerotic vascular disease, connective tissue disease and minor trauma [ [6] , [7] , [8] , [9] , [10] ]. These predisposing factors are supposed to be regarded as background of progressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Indirect carotid–cavernous sinus fistula following mechanical thrombectomy: A case report of a rare iatrogenic injury with progressive presentation

Wang

Shen

et al. 2022

Annals of Medicine &Amp; Surgery

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Clinical improvement in indirect carotid cavernous fistulas treated endovascularly: A patient based review

Cited by 4 publications

References 30 publications

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

Serous retinal detachment secondary to an unsuccessful transarterial embolization in a post-traumatic carotid-cavernous sinus fistula patient: A case report

Indirect carotid–cavernous sinus fistula following mechanical thrombectomy: A case report of a rare iatrogenic injury with progressive presentation

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