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Meta-Analysis
. 2021 May:204:106601.
doi: 10.1016/j.clineuro.2021.106601. Epub 2021 Mar 20.

Carotid cavernous fistula (CCF) treatment approaches: A systematic literature review and meta-analysis of transarterial and transvenous embolization for direct and indirect CCFs

Pavlos Texakalidis  1 , Andreas Tzoumas  2 , Dimitrios Xenos  2 , Dennis J Rivet  3 , John Reavey-Cantwell  3
Affiliations
Meta-Analysis

Carotid cavernous fistula (CCF) treatment approaches: A systematic literature review and meta-analysis of transarterial and transvenous embolization for direct and indirect CCFs

Pavlos Texakalidis et al. Clin Neurol Neurosurg. 2021 May.

Abstract

Background: Carotid Cavernous Fistulas (CCFs) are the result of an abnormal communication between the carotid artery and its branches and the venous system of the cavernous sinus. The mainstay of therapy for CCFs consists of transarterial or transvenous embolization, while other treatment options such as open surgery or radiosurgery are still utilized as second-line or adjuvant therapeutic options.

Objective: Our aim was to systematically review and summarize available data regarding short- and long-term outcomes of all available treatment modalities for CCFs.

Methods: This systematic review was conducted according to the PRISMA guidelines. A random effects model meta-analysis was conducted.

Results: Fifty-seven studies comprising 1575 patients were included in this systematic review. Transarterial embolization for direct and indirect CCFs offered a complete obliteration rate of 93.93% (N = 589/627) and 81.51% (N = 119/146), respectively. Transvenous embolization for direct and indirect lesions achieved obliteration in 91.67% (N = 33/36) and 86.03% (N = 425/494) of patients, respectively. Comparison between transarterial and transvenous embolization did not reveal statistically significant differences in terms of fistula obliteration for direct (OR: 1.42; 95% CI: 0.23-8.90; I2 0.0%) and indirect CCFs (OR: 0.62; 95% CI: 0.31-1.23; I2 0.0%).

Conclusions: Endovascular embolization techniques are the preferred treatment modality for the management of CCFs. No differences were identified between transarterial and transvenous embolization by synthesizing studies with available data. Future prospective cohorts are warranted to compare the different materials and techniques implemented especially within the rapidly expanding realm of endovascular approaches.

Keywords: Carotid cavernous fistula; Endovascular; Stereotactic radiosurgery; Transarterial; Transvenous.

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