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- Title
Embolization techniques of spontaneous direct carotid-cavernous fistulae: a single-center experience.
- Authors
Lindgren, Antti; Ahmed, Syed Uzair; Bodani, Vivek; Chung, Emily; Agid, Ronit; Barazarte, Hugo Andrade; Nicholson, Patrick Joseph; Schaafsma, Joanna Danielle; Radovanovic, Ivan; Terbrugge, Karel; Mosimann, Pascal Roger; Krings, Timo; Hendriks, Eef J.
- Abstract
Purpose: Spontaneous direct carotid-cavernous fistula (CCF) are usually caused by a ruptured carotid cavernous aneurysm. We studied treatment of spontaneous direct CCFs in a single-center cohort of a high-volume tertiary referral center, reporting anatomical details, technical approaches of treatment, and outcomes. Methods: Adult patients with a spontaneous direct CCF treated between 2010–2022 with follow-up MRI and/or DSA imaging available were retrospectively analyzed. We studied age, sex, clinical presentation, angiographic findings, treatment techniques, outcomes, and complications. Results: Out of 80 patients with CCFs, twelve patients were treated for a non-traumatic direct CCF (15%) in 13 sessions. Median age was 65 years. Two patients had an underlying connective tissue disorder. In 10 cases, the direct CCF was caused by a ruptured cavernous carotid aneurysm. The direct CCFs were treated by endovascular transarterial embolization (10 cases), transvenous embolization (1 case), or surgery (1 case). Selective closure of the shunt was possible in 10 patients. Two patients were treated with parent vessel occlusion (PVO; one endovascular; one surgical, with bypass). Complications occurred in 2 / 12 patients (17%), with permanent morbidity in two patients (17%): trigeminal neuralgia after PVO and new infarct after surgical PVO and bypass. Selective closure of CCF resulted in no morbidity. There was no mortality in our series. Conclusion: Spontaneous direct CCFs are caused by rupture of a cavernous carotid aneurysm in most cases. Selective closure of the shunt, usually feasible transarterially with coils, achieves good results. Reconstructive endovascular techniques are preferred to minimize treatment related neurological complications.
- Subjects
CAROTID artery surgery; CAROTID artery; THERAPEUTIC embolization; TREATMENT effectiveness; TERTIARY care; MAGNETIC resonance imaging; RETROSPECTIVE studies; ANGIOGRAPHY; ENDOVASCULAR surgery; DESCRIPTIVE statistics; ARTERIOVENOUS fistula; SURGICAL complications
- Publication
Neuroradiology, 2024, Vol 66, Issue 9, p1625
- ISSN
0028-3940
- Publication type
Article
- DOI
10.1007/s00234-024-03389-w