Abstract：
Direct carotid cavernous fistulas (dCCF) involve pathologic shunting from the internal carotid artery into the cavernous sinus. We systematically reviewed the methods and outcomes of endovascular therapy for dCCF.
PubMed, Scopus, and EMBASE were used to identify studies that reported outcomes for patients undergoing embolization of dCCF. Outcomes included rates of occlusion, complications, symptom improvement, and recurrence. Pooled rates for each outcome were obtained with random effects models. The influence of embolization method on outcomes was assessed with meta-regressions.
There were 16 studies comprising 270 patients. The mean age was 39.6 years, there were 36.3% females, and the mean follow-up was 19.7 months. Coils were the most common method of embolization (69.3%), followed by Onyx (31.1%), covered stent (22.2%), N-butyl cyanoacrylate (6.7%), and flow diversion (4.8%). The pooled overall occlusion rate was 92.1% (95% confidence interval [CI], 86.3-95.6; I2 = 29.2%). The pooled complication rate was 10.9% (95% CI, 7.3-16; I2 = 0%). Use of coils were associated with a slightly lower odds of overall complications (odds ratio, 0.98; 95% CI, 0.97-0.99) and cranial nerve palsy (odds ratio, 0.98; 95% CI, 0.97-0.99). The pooled fistula recurrence rate was 8.3% (95% CI, 4.3-15.4; I2 = 30.9%).
Endovascular therapy for dCCF is associated with high occlusion and low complication rates. Recurrence is not uncommon, highlighting the need for close follow-up.
PubMed, Scopus, and EMBASE were used to identify studies that reported outcomes for patients undergoing embolization of dCCF. Outcomes included rates of occlusion, complications, symptom improvement, and recurrence. Pooled rates for each outcome were obtained with random effects models. The influence of embolization method on outcomes was assessed with meta-regressions.
There were 16 studies comprising 270 patients. The mean age was 39.6 years, there were 36.3% females, and the mean follow-up was 19.7 months. Coils were the most common method of embolization (69.3%), followed by Onyx (31.1%), covered stent (22.2%), N-butyl cyanoacrylate (6.7%), and flow diversion (4.8%). The pooled overall occlusion rate was 92.1% (95% confidence interval [CI], 86.3-95.6; I2 = 29.2%). The pooled complication rate was 10.9% (95% CI, 7.3-16; I2 = 0%). Use of coils were associated with a slightly lower odds of overall complications (odds ratio, 0.98; 95% CI, 0.97-0.99) and cranial nerve palsy (odds ratio, 0.98; 95% CI, 0.97-0.99). The pooled fistula recurrence rate was 8.3% (95% CI, 4.3-15.4; I2 = 30.9%).
Endovascular therapy for dCCF is associated with high occlusion and low complication rates. Recurrence is not uncommon, highlighting the need for close follow-up.
摘要：
背景：直接颈动脉海绵窦瘘（dCCF）涉及从颈内动脉到海绵窦的病理性分流。我们系统回顾了dCCF的血管内治疗方法和结果。
方法：PubMed，Scopus,和EMBASE用于确定报告接受dCCF栓塞的患者结局的研究.结果包括闭塞率，并发症,症状改善,和复发。用随机效应模型获得每个结果的汇集率。通过荟萃回归评估栓塞方法对结局的影响。
结果：共有16项研究包括270例患者。平均年龄为39.6岁,有36.3%的女性，平均随访时间为19.7个月。线圈是最常见的栓塞方法（69.3％），其次是Onyx（31.1％），覆膜支架（22.2%），氰基丙烯酸正丁酯(6.7%),和分流(4.8%)。合并的总体闭塞率为92.1%(95%置信区间[CI]，86.3-95.6；I2=29.2%）。合并并发症发生率为10.9%（95%CI，7.3-16；I2=0%）。使用线圈与总体并发症的几率略低相关(优势比，0.98；95%CI，0.97-0.99)和颅神经麻痹(比值比，0.98；95%CI，0.97-0.99）。合并瘘复发率为8.3%(95%CI,4.3-15.4;I2=30.9%)。
结论：dCCF的血管内治疗与高闭塞和低并发症发生率相关。复发并不少见，强调需要密切跟进。
方法：PubMed，
结果：共有16项研究包括270例患者。
结论：dCCF的血管内治疗与高闭塞和低并发症发生率相关。
