Endovascular treatment of carotid-cavernous fistulae: Long-term efficacy and prognostic factors
Details
Serval ID
serval:BIB_A6C04EA831F6
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Endovascular treatment of carotid-cavernous fistulae: Long-term efficacy and prognostic factors
Journal
J Fr Ophtalmol
ISSN
1773-0597 (Electronic)
ISSN-L
0181-5512
Publication state
Published
Issued date
01/2016
Volume
39
Number
1
Pages
74-81
Language
english
Notes
Stephan, S
Blanc, R
Zmuda, M
Vignal, C
Barral, M
Pistocchi, S
Piotin, M
Galatoire, O
eng
France
2015/12/15
J Fr Ophtalmol. 2016 Jan;39(1):74-81. doi: 10.1016/j.jfo.2015.04.021. Epub 2015 Dec 2.
Blanc, R
Zmuda, M
Vignal, C
Barral, M
Pistocchi, S
Piotin, M
Galatoire, O
eng
France
2015/12/15
J Fr Ophtalmol. 2016 Jan;39(1):74-81. doi: 10.1016/j.jfo.2015.04.021. Epub 2015 Dec 2.
Abstract
INTRODUCTION: Carotid-cavernous fistulae are rare and affect visual prognosis. Their clinical presentation is varied and delayed diagnosis is common. They require rapid neuro-radio-ophthalmologic management. PURPOSE: The goal of this study was to evaluate the long-term efficacy and prognostic factors for treatment of carotid-cavernous fistulas by embolization. MATERIALS AND METHODS: A total of 60 patients with direct (10/60, 17%) or indirect (50/60, 83%) carotid-cavernous fistulae suspected during ophthalmological examination underwent cerebral angiography from December 2003 to October 2013. Of these, 59 (59/60, 98%) patients were treated with embolization. Treatment response was assessed with a follow-up angiogram confirming the exclusion of the fistula, and clinically by resolution of the initial symptoms. RESULTS: The diagnosis was suspected on the basis of proptosis in 45 patients (45/60, 75%), corkscrew episcleral vessels in 38 patients (38/60, 63%), chemosis in 37 patients (37/60, 61%), and diplopia in 30 patients (30/60, 50%). The median delay in diagnosis was 5 +/- 5 months [0.5 to 24 months], and mean follow-up was 31 +/- 31.5 months [0.5-118 months]. Eighteen patients (18/60, 30%) were lost to follow-up. Clinical response was complete in 24 patients (24/42, 57%) and partial in 14 patients (14/42, 33.5%). Symptoms were stable in one patient (1/42, 2.5%) and worsened in 3 patients (3/42, 7%). Morbidity per procedure was 3.3% and there was no postoperative mortality. Forty patients (40/60, 67%) had radiological follow-up and 39 patients (39/40, 97.5%) had a complete exclusion of the fistula. The presence of diplopia on initial examination was more frequently associated with an incomplete cure (P=0.04). CONCLUSION: The combination of proptosis, corkscrew episcleral vessels and diplopia should rapidly lead to head imaging to search for a carotid-cavernous fistula. Fistula embolization is a safe and effective treatment. The presence of diplopia on initial examination may be associated with a poorer outcome (P=0.044).
Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Anticoagulants/therapeutic use, Carotid-Cavernous Sinus Fistula/complications/diagnosis/diagnostic imaging/drug, therapy/*therapy, Cerebral Angiography, Child, Combined Modality Therapy, Delayed Diagnosis, Diplopia/etiology, Embolization, Therapeutic/*methods, Endovascular Procedures/*methods, Exophthalmos/etiology, Eye Pain/etiology, Facial Paralysis/etiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors/therapeutic use, Prognosis, Risk Factors, Treatment Outcome, Young Adult, Carotid-cavernous fistulae, Diplopia, Diplopie, Embolisation, Embolization, Exophtalmie, Exophthalmia, Facteurs pronostiques, Fistule carotido-caverneuse, Prognostic factors, Proptosis, Ptosis
Pubmed
Create date
23/02/2024 14:01
Last modification date
24/02/2024 7:35