Transarterial Embolization of Direct Carotid Cavernous Fistula by Coils

Abstract
Background: Type A CCFs (direct CCFs) usually resulting from tear in the carotid wall. Clinical presentations were due to increased venous pressure and presents by classic triad of exophthalmos, chemosis, and bruit. Cerebral angiography still the gold standard in diagnosis, classification and planning of treatment. Type A CCFs mandates endovascular intervention.
Aim of Study: The aim of this study to evaluate safety and efficacy of transarterial approach by using coils for treatment of direct CCFs.
Patients and Methods: This study conducted on all patients with direct carotid cavernous fistula admitted to Department of Neurosurgery, Tanta University between December 2010 and November 2016.
Results: Twelve patients including 10 male and 2 female, with a mean age of 33 years. All patients had symptoms and signs related to direct CCF. In 12 patients (100%) complete obliteration of the CCF was achieved at control angiogram at the end of the procedure. ICA was preserved in 9 patients (75%) while carotid occlusion in addition was done in 3 patients (25%) without permanent morbidity or mortality.
Conclusions: Transarterial embolization of direct carotid cavernous fistula by coils is effective, safe technique and better alternative to balloons in the treatment of direct carotid cavernous fistula.