Transarterial detachable coil embolization of direct carotid-cavernous fistula: Immediate and long-term outcomes

Chao Bao Luo*, Michael Mu Huo Teng, Feng Chi Chang, Chung Jung Lin, Wan Yuo Guo, Cheng Yen Chang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background: Transarterial embolization is a standard method for management of direct carotid-cavernous fistula (DCCF). The purpose of this study was to report our experiences, and immediate and long-term outcomes of endovascular embolization of DCCFs by using detachable coils (DCs). Methods: Over 8 years, 24 patients with 25 DCCFs underwent endovascular DC embolization. There were 15 men and nine women; age ranged from 8 to 82 years (mean, 39 years). Immediate and long-term angiographic as well as clinical outcomes after endovascular DC embolization were retrospectively analyzed. The number and the length of DCs used to occlude the fistula were also evaluated. Results: Eighteen DCCFs were successfully occluded by single-session endovascular embolization with preservation of the parent artery. Retreatments by transvenous (n = 5) and/ or transorbital routes (n = 3) had to be performed in seven patients because of residual fistula (n = 4) or recurrent fistula (n = 4) occurring within 3 weeks after embolization. The average numbers and length of coils to occlude the fistulas were 14 (range, 2-31) and 189 cm (range, 16-756 cm), respectively. Four patients had small residual fistulas with spontaneous thrombosis on follow-up angiography. Three patients had transient cranial nerve impairment of the third (n = 1) or sixth (n = 2) nerve. There was no significant procedure-related neurological complication. The follow-up period was 3-48 months (mean, 19 months). Conclusion: Endovascular DC embolization of DCCFs was proved both efficacious and safe in managing high-flow fistulas with sustained angiographic and clinical effects, particularly in those DCCFs with small fistula track and/or cavernous sinus. However, retreatment via various routes may be necessary in some patients because of residual or recurrent fistulas.

Original languageEnglish
Pages (from-to)31-36
Number of pages6
JournalJournal of the Chinese Medical Association
Volume76
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • Detachable coil
  • Direct carotid-cavernous fistula
  • Embolization
  • Outcome

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