Endovascular treatment in 25 patients with carotid-cavernous sinus fistula

Abstract

Objective To summarize the preliminary experience of coils, Onyx and covered stents for the treatment of carotid-cavernous sinus fistula （CCF）. Methods Of the 25 patients with CCF, 22 were traumatic CCF, and 3 were spontaneous CCF; the fistula orifices of 14 patients were located in the cavernous segment of right internal carotid artery （ICA）, and 11 were located in the cavernous segment of left ICA. According to the Barrow classification, Types A, C, and D were 22, 2, and 1, respectively. Eighteen patients were treated with Guglielmi detachable coils alone, 1 was treated with Guglielmi detachable coils and Onyx, 2 were treated with Onyx alone, and 4 were treated with covered stents. Results Intracranial bruit disappeared immediately in all patients after the procedures. Postoperative angiography showed complete occlusion of the fistula orifices, the symptoms disappeared after 1 to 20 days, and there were no death and procedure-related complications. The recanalized ICAs were patent in patients （12/18） treated with coils, and the ICAs were patent in4 patients treated with the covered stents. The ICAs were patent in 2 patients treated with Onyx, the ICA was patent in 1 patent treated with detachable coils and Onyx. One patient with traumatic CCF treated with coils had clinical recurrence, and was cured after re-embolization with coils. The remaining patients were followed-up for 6 to 24 months, and no recurrence of clinical symptoms was found. The follow- up cerebral angiography of 6 patients was obtained, and no CCF recurrence was observed.Conclusion Endovascular treatment with Guglielmi detachable coils, Onyx, and covered stents is a safe and useful method for closing CCFs. Key words: Carotid-cavernous sinus fistula;  Embolization, therapeutic