Endovascular embolization of carotid–cavernous fistulas: a single-center analysis of safety, technical success, and long-term outcomes

INTRODUCTION: Carotid-cavernous fistulas (CCFs) are abnormal shunts between the internal carotid artery and the cavernous sinus that may be high-flow direct or low-flow indirect lesions. They present with ocular symptoms and headache and are diagnosed primarily by cerebral angiography. This study evaluated the safety, technical success, and long-term outcomes of endovascular embolization for CCFs. MATERIAL AND METHODS: This retrospective single-center study evaluated procedural and clinical outcomes of patients with CCFs treated with endovascular embolization. The evaluated outcomes included immediate procedural success on DSA, symptom resolution, procedure-related complications, and the rate of complete fistula occlusion on follow-up DSA. RESULTS: Twenty-three patients (mean age 57 years; 74% female) underwent endovascular treatment for carotid-cavernous fistulas, including 11 direct and 12 indirect lesions. The most common presenting symptoms were proptosis and orbital pain. Coil embolization was used in all cases, with adjunctive materials in 44% (10/23). Immediate complete occlusion was achieved in 48% (11/23) and complications occurred in 9% (2/23). Final follow-up DSA showed complete fistula closure in 91.3% of patients (21/23). Clinical improvement was achieved in 91.3% (21/23) of the cohort, with complete clinical resolution in 14 patients (61%). CONCLUSIONS: The results of our study suggest that long-term radiological and clinical outcomes in patients with CCFs treated with endovascular embolization were very satisfactory across all fistula types. Therefore, modern endovascular methods should be considered during the multidisciplinary evaluation of these patients.