Direct carotid cavernous sinus fistulae: vessel reconstruction using flow-diverting implants

Area of Science:

• Neurology
• Interventional Radiology
• Vascular Surgery

Background:

• Direct carotid-cavernous sinus fistulae (diCCF) are rare, complex vascular malformations.
• Endovascular treatment is the preferred approach for diCCF.
• Flow diverters (FD) have emerged as a potential treatment modality.

Purpose of the Study:

• To evaluate the safety and efficacy of flow diverters (FD) in treating direct carotid-cavernous sinus fistulae (diCCF).
• To assess the technical success, clinical outcomes, and complications associated with FD treatment for diCCF.

Main Methods:

• Retrospective analysis of 14 consecutive patients with diCCF treated between 2011 and 2015.
• Treatment involved FD alone or in combination with other endovascular devices (covered stents, coils).
• Devices used included Pipeline Embolization Device and p64 Flow Modulation Device.

Main Results:

• FD placement was technically successful in all 14 patients without immediate adverse events.
• Complete diCCF occlusion after the first session was achieved in 3/14 patients; significant reduction in shunt volume in 4/14.
• At a mean follow-up of 20 months, 71% of patients were free from ocular symptoms; 2 patients had residual exophthalmos.

Conclusions:

• Flow diverters provide a safe and effective endovascular option for diCCF treatment.
• Adjunctive treatments like venous coil occlusion and multiple FD layers may be necessary for complete closure.
• Long-term antiaggregation is crucial, and flexible stent grafts may offer future advantages.