Endovascular Treatment in Traumatic and Spontaneous Carotid Cavernous Fistulas: with Different Embolization Agents and via Various Vascular Routes

Abstract

Purpose—We evaluated carotid cavernous fistula (CCF) cases which were treated with various vascular
routes and different embolization agents. Our aim was to present endovascular treatment procedures, clinical and radiological findings, and to discuss the safety and clinical efficacy of the treatment.
Materials and Methods—The demographic information, presenting symptoms and clinical findings of
25 CCF cases in 23 patients treated with endovascular route were reviewed. The type of fistula, the feeding
arteries, the draining veins, and the details of the treatment were documented on the basis of digital subtraction angiography (DSA) images. The efficacy of the treatment was evaluated according to current and follow-up DSA findings with clinical symptoms.
Results—All of which 25 CCF were closed to the fullest extent, one of them closed spontaneously, 20
were closed in one session and 4 in two sessions (100%). 18 of the cases (75%; 18/24) were treated with a
venous approach, 5 cases (21%; 5/24) with an arterial approach, and 1 case (4%; 1/24) with a combined
arterial-venous approach. Coils were used in 18 cases (75%; 18/24), a covered stent was used in 1 case
(4%; 1/24), a detachable balloon was used in 1 case (4%; 1/24), n-Butyl Cyanoacrylate was used in 1 case
(4%; 1/24), and combined (2 stent-coil, 1 coil-ethylene vinyl alcohol copolymer) embolization agents were
used.
Conclusion—The endovascular treatment of CCF has high success and low complication rates. The significant point of the treatment is achieving complete fistula obliteration in the least possible number of sessions with appropriate embolization agents