A Modified Treatment Through Point-to-Point Coil Embolization for Direct Carotid Cavernous to Fistula: A Single-Center Result.

Zihuan Zhang,Zhenbao Li,Mengliang Zhou,Xintong Zhao,Jiaqiang Liu,Bingbing Zhang

doi:10.3389/fneur.2021.639552

Abstract

This study aims to assess the safety and efficacy of the modified treatment through point-to-point coil embolization of direct carotid cavernous fistula (dCCF), and evaluate the long-term outcome of patients who underwent the above treatment. A total of 18 patients who suffered from dCCF (a total of 19 fistulas) between January 2013 to May 2020 were analyzed. Among these patients, 14 patients were treated through point-to-point coil embolization of the fistula, while four patients were treated through combined endovascular embolization (coils, a balloon, Onyx, and/or a stent). The number of coils that filled the fistulas was counted. The primary outcome was defined by post-operative digital subtraction angiography (DSA) or the signs after the recanalization of dCCFs during the follow-up period. For patients with dCCF who underwent point-to-point coil embolization, a minimum of three coils and a maximum of 16 coils were used for these 14 fistula patients, and an average of 7.9 coils were used for each fistula, but none of the fistulas was recanalized. Furthermore, two pseudoaneurysms were observed as a result of the compression of the coils. However, none of these 14 patients presented with signs of recanalization of fistulas or cranial paralysis. The procedure applied for the present study was shown to be a safe, economical and efficacious treatment approach for dCCFs through the point-to-point coil embolization of the fistula.

Highlights

The types of treatment for direct carotid cavernous fistula have been gradually developed from early internal carotid artery (ICA) occlusion and balloon embolism, to the present detachable coil combined with Onyx, covered stent treatment, flow diversion of the parent vessel, etc
There are different kinds of advanced treatments available for treating carotid cavernous fistula (CCF), such as balloon embolization [3], covered stents [4], and detachable coils combined with Onyx embolization [5]
Balloon embolization has been used in practice due to its advantages, such as practicality and keeping the ICA unobstructed

Summary

Introduction

The types of treatment for direct carotid cavernous fistula (dCCF) have been gradually developed from early internal carotid artery (ICA) occlusion and balloon embolism, to the present detachable coil combined with Onyx, covered stent treatment, flow diversion of the parent vessel, etc. These procedures include some drawbacks, such as recanalization, high cost and poor maneuverability. The right ICA showed complete occlusion of the fistula and patency of the parent artery (Figure 1J). The good outcome of this patient suggests that this procedure is feasible for treating the dCCF by simple coil embolization of the fistula

Objectives

Methods

Findings

Conclusion