Aims: To describe the diagnostic and therapeutic value of digital subtraction angiography (DSA) and endovascular treatment in patients with direct carotid cavernous fistula (CCF) over a period of three years.

Settings: Tertiary referral hospital, Chhattisgarh

Design: Retrospective, noncomparative case series.

Material & Methods: Medical records of consecutive patients who had direct CCF between January 2014 to January 2017 with minimum six months of follow-up were retrospectively analyzed. All patients were initially evaluated by non-invasive imaging technique followed by DSA for confirmation. Endovascular embolization was done in all cases. A clinical cure was considered when there was a complete resolution of signs and symptoms of direct CCF and when the fistula was not observed on repeat DSA after three months, which was labeled as anatomically cured patients. 

Results: Total ten patients were analyzed; nine patients had unilateral CCF, only one had bilateral CCF. All patients had history of head trauma. Five (50%) patients were embolized with a coil, and the rest were embolized by a combination of coil and Onyx. In our study, carotid artery preservation was performed in 70% of patients. Latest clinical follow up showed good recovery Furthermore no procedure related complications were noted in any patients. There were no intraoperative or perioperative mortality noted.

 

Conclusion: With the observed results and low rate of complications and morbidity, endovascular therapy could be the primary treatment for patients with direct CCFs.