Endovascular treatment of carotid-cavernous fistulae: Long-term efficacy and prognostic factors

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• 作者：S. Sté ; phan^a ; ^{sofi.stephan@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; R. Blanc^b ; M. Zmuda^a ; C. Vignal^c ; M. Barral^b ; S. Pistocchi^b ; M. Piotin^b ; O. Galatoire^a
• 关键词：Carotid-cavernous fistulae ; Embolization ; Prognostic factors ; Proptosis ; Diplopia ; Exophthalmia
• 刊名：Journal Français d'Ophtalmologie
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：39
• 期：1
• 页码：74-81
• 全文大小：974 K

文摘

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).