Characteristics of Patients with Carotid-Cavernous Fistula who Underwent Endovascular Intervention

Abstract

Carotid cavernous fistula (CCF) is an abnormal connection between the arterial and venous systems within the cavernous sinus. Direct CCF is usually created from a tear in the intracavernous carotid artery wall. Indirect CCF often develops spontaneously and causes subtle manifestations. Direct CCF, commonly characterized by high blood flow, usually exhibits oculo-orbital venous congestion and cephalic bruit. The low-flow indirect CCF commonly presents with similar manifestations but is more subtle in nature. Generally, direct CCF requires endovascular treatment. This is done to seal the fistula while preserving the patency of the internal carotid artery (ICA). A retrospective descriptive study was conducted on 44 patients with CCF who underwent endovascular intervention at Cipto Mangunkusumo Hospital, Indonesia, between 2014 and 2021. Data from medical records were analyzed to assess patient characteristics, clinical presentations, radiological findings, and treatment modalities.Most patients presented with ocular bruit (74.4%) and proptosis (68.1%), with high-flow (59.1%) and type A (90.9%) CCF being predominant. Endovascular interventions included balloon insertion (80.9%), coil insertion (9.1%), and combined balloon and coil procedures (9.1%). When performed by an experienced interventionist, the success rates of fistula closure could be as high as 85%-99% and 70%-78% for direct and indirect fistula, respectively. CCF is a non-life-threatening condition but can lead to severe clinical consequences. Recognition of characteristics is significant in helping to guide appropriate and timely treatment for patients. Serious complications are rare.