Endovascular Management of Direct Carotid–Cavernous Fistula: Evolution of Cost Effective Sandwich Technique

• Published in: Journal of neurosciences in rural practice Vol. 11; no. 4; pp. 558 - 564
• Main Authors: Prasad, Surya N., Singh, Vivek, Boruah, Deb K., Phadke, Rajendra V., Sharma, Kumudini, Kannaujia, Vikas
• Format: Journal Article
• Language: English
• Published: A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Thieme Medical and Scientific Publishers Pvt. Ltd 01.10.2020
• Subjects: Original; Original Article; sandwich technique; carotid cavernous fistula; embolization; parent vessel occlusion; detachable balloons
• ISSN: 0976-3147; 0976-3155; 0976-3147
• DOI: 10.1055/s-0040-1714447

Abstract Objective  There is a direct fistulous connection between the cavernous segment of the internal carotid artery and cavernous sinus in cases of direct carotid–cavernous fistula (CCF). Endovascular embolization is the mainstay of management in this condition. This study is about the evolution of endovascular treatment methods and the development of a cost-effective technique for embolization of direct CCF at a tertiary care center. Materials and Methods  A retrospective analysis was performed of all the cases of direct type CCF embolized by endovascular techniques in our department from 2008 to 2018.Clinical follow-up of these patients was done at 1 week, 3 months, and 6 months. Results  A total of 45 patients with 40 having a prior history of head trauma were included in this study. All cases were treated with a transarterial route except one which was treated with the transvenous approach. Detachable balloon s were used in 12 (26.67%) patients, only detachable coils in 14 cases (31.11%), both detachable balloons and coils in 9 cases (20%), and both detachable and push coils, that is, sandwich technique in 8 cases (17.78%). Parent arterial occlusion was performed in 10 patients (22.22%). There was complete resolution of chemosis and bruit in all the patients. Conclusion  Endovascular treatment is the mainstay of management in direct CCF. Using more fibered thrombogenic coils in a sandwich manner decreases the cost of the treatment significantly.