Abstract：
To evaluate the safety and efficacy of endovascular treatment with a combination of Onyx and coils for carotid cavernous fistulas (CCFs), and to characterize the factors associated with clinical and angiographic outcomes for direct and indirect CCFs.
This retrospective study included 31 patients with CCF treated with an endovascular procedure between December 2017 and March 2022.
Direct and indirect CCFs were found in 14 (45.2%) and 17 (54.8%) cases, respectively. Direct CCFs included eleven traumatic carotid cavernous fistulas. The most common symptom on admission was chemosis, which was seen in 17 (54.8%) patients. Eight (25.7%) cases were treated by the transarterial approach. Fourteen (45.2%) cases were treated using the femoral vein-inferior petrosal sinus approach. Seven (22.6%) were treated by direct puncture of the superior ophthalmic vein. Two (6.5%) were treated by the femoral vein-facial vein approach. Immediate complete occlusion and follow-up rates were 93.5% and 96.7%, respectively. Twenty-nine (96.7%) patients experienced an improvement in their symptoms at clinical follow-up. Chemosis was significantly improved or resolved in 15 patients. Ophthalmoplegia was improved or resolved in 10 patients. Visual impairment was improved in 6 patients. Proptosis was improved or resolved in 5 patients. One case (3.2%) experienced procedure-related complication presented with transient oculomotor nerve palsy. In univariate subgroup analysis, use of balloon, treatment approach, and history of head trauma were significantly different between the direct and indirect CCF groups.
Endovascular treatment with a combination of Onyx and coils is a safe and effective therapy for CCFs. In this study, the transarterial approach was a favorable option for embolization of direct CCFs. In contrast, the transvenous approach may be the first choice of treatment for indirect CCFs.
This retrospective study included 31 patients with CCF treated with an endovascular procedure between December 2017 and March 2022.
Direct and indirect CCFs were found in 14 (45.2%) and 17 (54.8%) cases, respectively. Direct CCFs included eleven traumatic carotid cavernous fistulas. The most common symptom on admission was chemosis, which was seen in 17 (54.8%) patients. Eight (25.7%) cases were treated by the transarterial approach. Fourteen (45.2%) cases were treated using the femoral vein-inferior petrosal sinus approach. Seven (22.6%) were treated by direct puncture of the superior ophthalmic vein. Two (6.5%) were treated by the femoral vein-facial vein approach. Immediate complete occlusion and follow-up rates were 93.5% and 96.7%, respectively. Twenty-nine (96.7%) patients experienced an improvement in their symptoms at clinical follow-up. Chemosis was significantly improved or resolved in 15 patients. Ophthalmoplegia was improved or resolved in 10 patients. Visual impairment was improved in 6 patients. Proptosis was improved or resolved in 5 patients. One case (3.2%) experienced procedure-related complication presented with transient oculomotor nerve palsy. In univariate subgroup analysis, use of balloon, treatment approach, and history of head trauma were significantly different between the direct and indirect CCF groups.
Endovascular treatment with a combination of Onyx and coils is a safe and effective therapy for CCFs. In this study, the transarterial approach was a favorable option for embolization of direct CCFs. In contrast, the transvenous approach may be the first choice of treatment for indirect CCFs.
摘要：
背景：为了评估使用Onyx和线圈联合治疗颈动脉海绵窦瘘（CCF）的血管内治疗的安全性和有效性，并描述与直接和间接CCF的临床和血管造影结果相关的因素。
方法：这项回顾性研究包括2017年12月至2022年3月期间接受血管内手术治疗的31例CCF患者。
结果：在14例（45.2％）和17例（54.8％）中发现了直接和间接CCF，分别。直接CCF包括11个创伤性颈动脉海绵窦瘘。入院时最常见的症状是放化疗，在17例（54.8%）患者中观察到。经动脉入路治疗8例(25.7%)。采用股静脉-岩下窦入路治疗14例（45.2％）。通过直接穿刺眼上静脉治疗了7例（22.6％）。2例（6.5％）采用股静脉-面静脉入路治疗。即刻完全闭塞和随访率分别为93.5%和96.7%,分别。29名（96.7％）患者在临床随访中症状有所改善。15例患者化疗得到明显改善或缓解。10例患者眼肌麻痹得到改善或解决。6例患者视力障碍得到改善。5例患者的下垂得到改善或缓解。1例（3.2％）经历了与手术相关的并发症，并表现为短暂性动眼神经麻痹。在单变量亚组分析中，使用气球，治疗方法,直接CCF组和间接CCF组的头部外伤史有显著差异。
结论：结合Onyx和线圈的血管内治疗是一种安全有效的CCF治疗方法。在这项研究中,经动脉途径是直接CCF栓塞的有利选择.相比之下,经静脉途径可能是间接CCF的首选治疗方法.
方法：这项回顾性研究包括2017年12月至2022年3月期间接受血管内手术治疗的31例CCF患者。
结果：在14例（45.2％）和17例（54.8％）中发现了直接和间接CCF，分别。直接CCF包括11个创伤性颈动脉海绵窦瘘。入院时最常见的症状是放化疗，在17例（54.8%）患者中观察到。经动脉入路治疗8例(25.7%)。采用股静脉-岩下窦入路治疗14例（45.2％）。通过直接穿刺眼上静脉治疗了7例（22.6％）。2例（6.5％）采用股静脉-面静脉入路治疗。即刻完全闭塞和随访率分别为93.5%和96.7%,分别。29名（96.7％）患者在临床随访中症状有所改善。15例患者化疗得到明显改善或缓解。10例患者眼肌麻痹得到改善或解决。6例患者视力障碍得到改善。5例患者的下垂得到改善或缓解。1例（3.2％）经历了与手术相关的并发症，并表现为短暂性动眼神经麻痹。在单变量亚组分析中，使用气球，治疗方法,直接CCF组和间接CCF组的头部外伤史有显著差异。
结论：结合Onyx和线圈的血管内治疗是一种安全有效的CCF治疗方法。在这项研究中,经动脉途径是直接CCF栓塞的有利选择.相比之下,经静脉途径可能是间接CCF的首选治疗方法.
