Introduction:

The management of carotid-cavernous fistulas (CCF) may represent a therapeutic challenge, specially for those cases in which there is no spontaneous resolution and there is progression for this type of pathology. There are multiple approaches for this condition and the clinical results may be variable. The objective of this study is to describe the clinical and radiologic characteristics of patients with CCF treated at our center. We will present the endovascular treatment approaches (transvenous, transarterial), the evolution, complications and recurrence of CCFs.

Methods:

Retrospective review of our database from January 2007 until October 2015 of patients diagnosed with CCF. 31 patients (16 males/15 females) from a total of 62 diagnosed with CCF were identified who did not respond to non-endovascular management. 27 patients had direct CCF and 4 patients had indirect CCF. 4 patients had bilateral fistulae.

Results:

Age range was 26 to 88 years old (median was 58). The CCFs were related to trauma in 12 patients and spontaneous in 19 patients. Proptosis, orbital pain and chemosis were the most common clinical presentations. 4 patients required a stent to reconstruct the carotid artery. Approach was transarterial in 22 patients, transvenous in 6 and a combined approach was required in 3. Complications ocurred in 3 patients: inguinal hematoma (1), transient cerebral ischemia (1) and stroke with hemorrhagic conversion in (1). This last patient had severe fibromuscular displasia, but no permanent neurologic deficits.

Conclusions:

There is a significant number of patients with spontaneous resolution of CCF. Endovascular treatment is an effective and relatively safe method for those patients that do not respond to conservative management. The use of stents is very useful when the carotid artery is severely damaged and its patency is needed. Transvenous approach may present a higher visual morbidity.

Patient Care:

Reivew the treatment options and outcomes for CCF at our center. It will help in future treatment selection and planning and patient orientation.

Learning Objectives:

1) Describe the clinical presentations of CCFs. 2) Describe the endovascular treatment options for CCFs.

References:

1. Macho J, Guelbenzu S, Barrena R, Valles V, Ibarra B, Valero P. Carotid cavernous fistula: endovascular therapy. Rev Neurol 1996; 24: 59-64.          2. Chavis R, Krohel G, Perman K. Acute proptosis in adults. En: Tasman W, ed. Duane's clinical ophthalmology, vol 2, chap 28, Philadelphia, Lippincott-Raven publishers, 1997; pp 14.          3. Durcan F. Carotid cavernous fistula. En: Gold D, Weingest T, eds. The eye in systemic disease. Philadelphia, Lippincott, 1990; pp 658-60.