Transvenous Onyx Embolization of Carotid-Cavernous Fistulas: Mid- and Long-Term Outcomes

Beer‐Furlan, André; Joshi, Krishna C.; Brahimaj, Bledi; Lopes, Demetrius K.

doi:10.1055/s-0040-1710514

Cited by 6 publications

(6 citation statements)

References 22 publications

(23 reference statements)

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“…Cerebral angiography is the gold standard for definitive diagnosis, classification and therapeutic planning [ 1 ]. Recent advances in endovascular technology have expanded the range of treatment options for CCFs and favorable long-term outcomes have been achieved [ 2 – 4 ]. As a result, the mainstay of treatment for CCFs consists of transarterial or transvenous embolization.…”

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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“…The complication rate of EVT ranged between 2.3% and 53.3% across different studies. [2][3][4][5]13,15,24,25 In a systemic review and meta-analysis of 21 studies, Alexandre et al 15 found a complication rate of 7.8%. In our series, 23% of patients experienced different complications following EVT, which was more common following LEAs than coiling alone (32% vs 15%).…”

Section: Discussionmentioning

confidence: 99%

“…Ocular symptoms generally improved in 60%-100% of patients following EVT. 2,3,12,13,17,24 While proptosis, chemosis, and tinnitus could rapidly disappear following embolization, CN palsy and vision deficits take several months to improve. 29 In our series, 31% of patients showed immediate improvement of the ocular symptoms after EVT, which was more common following coiling alone (42.2%).…”

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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“…Several other studies have reported variable occlusion rates across the literature. [14][15][16][17] Beer-Furlan et al demonstrated a 100% complete occlusion rate following TV Onyx embolization of 3 direct and 4 indirect CCFs. 14 Suzuki et al treated 6 spontaneous CCFs transvenously using a combination of coils and Onyx with an immediate complete occlusion rate of 66.7%.…”

Section: Ta Approachmentioning

confidence: 99%

“…[14][15][16][17] Beer-Furlan et al demonstrated a 100% complete occlusion rate following TV Onyx embolization of 3 direct and 4 indirect CCFs. 14 Suzuki et al treated 6 spontaneous CCFs transvenously using a combination of coils and Onyx with an immediate complete occlusion rate of 66.7%. 16 Recurrence was seen in 2 cases and required a second treatment.…”

Section: Ta Approachmentioning

confidence: 99%

Comparison of the transarterial, transvenous, and superior ophthalmic vein approaches in the treatment of indirect carotid-cavernous fistulas

El Naamani,

Mouchtouris,

Majmundar

et al. 2024

Neurosurgical Focus

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OBJECTIVE Indirect carotid-cavernous fistulas (CCFs) are abnormal arteriovenous shunting lesions with a highly variable clinical presentation that depends on the drainage pattern. Based on venous drainage, treatment can be either transarterial (TA) or transvenous (TV). The aim of this study was to compare the outcomes of indirect CCF embolization via the TA, TV, and direct superior ophthalmic vein (SOV) approaches. METHODS The authors conducted a retrospective analysis of 74 patients admitted to their institution from 2010 to 2023 with the diagnosis of 77 indirect CCFs as confirmed on digital subtraction angiography. RESULTS A total of 74 patients with 77 indirect CCFs were included in this study. Embolization was performed via the TA approach in 4 cases, the TV approach in 50 cases, and the SOV in 23 cases. At the end of the procedure, complete occlusion was achieved in 76 (98.7%) cases. The rate of complete occlusion at the end of the procedure and at last radiological follow-up was significantly higher in the SOV and TV cohorts than in the TA cohort. The rate of recurrence was highest in the TA cohort (25% for TA vs 5.3% for TV vs 0% for SOV, p = 0.68). CONCLUSIONS The rate of immediate complete occlusion was higher in the TV and SOV cohorts than in the TA cohort while the rate of complete occlusion at final follow-up was highest in the SOV cohort. The SOV approach was significantly associated with higher rates of postoperative complications. Indirect CCFs require careful examination of the fistulous point and the venous drainage to provide the most effective patient-tailored approach.

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Transvenous Onyx Embolization of Carotid-Cavernous Fistulas: Mid- and Long-Term Outcomes

Cited by 6 publications

References 22 publications

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

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

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

Comparison of the transarterial, transvenous, and superior ophthalmic vein approaches in the treatment of indirect carotid-cavernous fistulas

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