Delhi Journal of Ophthalmology

High Diagnostic And Therapeutic Value of Digital Subtraction Angiography in Direct Carotid-Cavernous Fistulas: A Retrospective Case Series

Vijaya Sahu1, C.D. Sahu2, Nidhi Pandey3, Bhagyashri Bhutada4
1Department Of Ophthalmology, AIIMS Raipur, Chhattisgarh, India.
2,4Department of Radiology Pt. J. N. M. Medical College Raipur, Chhattisgarh, India.
3Department of Ophthalmology, Pt. J. N. M. Medical College Raipur, Chhattisgarh, India.

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.


Corresponding Author:

Vijaya Sahu (M.S. Ophthalmology)
Associate Professor, Department of Ophthalmology, AIIMS Raipur, Chhattisgarh, India
Email: drvijayasahu77@gmail.com


Received: 25-JUN-2021 Accepted: 26-JAN-2022 Published Online: 03-APR-2022
DOI: https://dx.doi.org/10.7869/djo.737

Abstract
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.

Keywords :Digital subtraction angiography, direct carotid cavernous fistulas, Endovascular embolization