Faculty Collaboration Database

Multimodal endovascular therapy of traumatic and spontaneous carotid cavernous fistula using coils, n-BCA, Onyx and stent graft. J Neurointerv Surg 2011 Sep;3(3):255-62

Date

10/13/2011

Pubmed ID

21990837

DOI

10.1136/jnis.2010.003103

Scopus ID

2-s2.0-80051747045 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND AND PURPOSE: Carotid cavernous fistula (CCF) can be classified as either direct or indirect according to the arterial feeder source. The current standard treatment for CCF is endovascular embolization. In this case series, 21 CCF (direct and indirect) embolization procedures were treated with multimodal endovascular therapy to explore safety, technique and clinical efficacy.

METHOD AND PATIENTS: The neurointerventional database was reviewed for all cases of CCF. Demographic information, indications for the procedure, presenting symptoms, endovascular therapy types, complications and procedure angiographic and clinical efficacy were collected.

RESULTS: 21 CCF embolization procedures were performed using multimodal therapy on 15 patients (eight females and seven males) with a mean age of 56.4±22.4 years (15-90 years), with 60% traumatic CCF and 40% spontaneous CCF presenting mainly with typical visual symptoms. 10 patients were treated in one session, four patients underwent two sessions and one required three sessions of endovascular therapy. Complete fistula occlusion was achieved in 10/15 patients (73.3%) in one session and in 14/15 (93.3%) patients after two or more sessions. One patient's symptoms (case No 15) improved dramatically after the second session despite incomplete obliteration of the CCF. No periprocedural complications were reported. Long term follow-up showed one recurrence of the CCF with a mean follow-up time of 201±17.2 months (range 1-56 months). Patient No 6 was lost to follow-up.

CONCLUSION: Multimodal endovascular embolization of CCF appears to be safe with a high success rate of complete obliteration. This case series demonstrates complete occlusion in 73.3% of the patients after one session and in 93.3% after the second session.

Author List

Zaidat OO, Lazzaro MA, Niu T, Hong SH, Fitzsimmons BF, Lynch JR, Sinson GP

Authors

Sang Hun Hong MD Assistant Professor in the Ophthalmology and Visual Sciences department at Medical College of Wisconsin
Marc A. Lazzaro MD Associate Professor in the Neurology department at Medical College of Wisconsin
Grant P. Sinson MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adhesives
Adolescent
Adult
Aged
Aged, 80 and over
Carotid-Cavernous Sinus Fistula
Dimethyl Sulfoxide
Embolization, Therapeutic
Enbucrilate
Female
Humans
Male
Middle Aged
Polyvinyls
Radiography
Retreatment
Retrospective Studies
Stents
Treatment Outcome
Young Adult