Assessment of clinical improvement in patients undergoing endovascular coiling in traumatic carotid cavernous fistulas

Abstract

Objectives: We attempt to find key points in endovascular coiling which can help us predict degree of clinical recovery, in an attempt to make the treatment of CCF safe and effective.

Patients and methods: We analyzed a series of 15 patients with traumatic CCFs undergoing coiling by performing clinical, angiographical and radiological assessment before and at regular time periods after the procedure till 6 months. The findings were analyzed to find critical points predicting clinical outcome in each of the patients.

Results: 80% patients had complete occlusion of fistula (n=12) with a 100% ICA patency rate. Angiographic occlusion of fistula, visualization of ophthalmic artery and disappearance of bruit predicted a good clinical outcome. Cranial nerve palsies and fixed neurological deficits do not always reverse suggesting an alternate etiopathology.

Conclusion: The degree of occlusion had direct correlation with improvement in clinical symptoms, which was remarkable when the extent of occlusion was more than 90%. To our knowledge this is one of the largest series in published literature on clinical outcomes of patients with traumatic CCFs using detachable coils as the embolizing agent and can serve as standard for comparison for future treatment alternatives.

Keywords: Carotid cavernous fistulas; Endovascular coiling; Retro orbital edema; Superior ophthalmic vein.