Endovascular treatment of carotid-cavernous fistulas in a medium-sized Scandinavian neurovascular center.

Purpose: Carotid-cavernous fistulas (CCFs) are treated almost exclusively by endovascular techniques, but the frequency of treatments is limited in smaller centers. We analyzed all CCFs treated in our hospital to determine if high-quality treatment of CCFs can be provided in a medium-volume neurovascular center.

Methods: Retrospective quality-control cohort study.

Results: From 2005 to 2021, 28 CCF-treatments were performed in our hospital, all endovascular. Fourteen were direct and fourteen were indirect CCFs. All direct CCFs were treated using transarterial coil embolization, and in seven of these the ICA was preserved. All indirect CCFs were treated using transvenous coil embolization. Complete cure was achieved after one procedure in 24 (85.7%) patients, and in all patients (100%) after retreatments. All CCF-patients experienced significant improvement of symptoms after treatment and 79.2% were asymptomatic after 6-12 months. Two patients with direct CCFs were blind on their ipsilateral eye before treatment and remained so after treatment. Three patients had reduced vision or visual field defects ipsilateral to their indirect CCFs that normalized after treatment. One patient suffered a minor asymptomatic thromboembolic event during the treatment (3.6%), otherwise there were no complications to treatments.

Conclusions: High-quality treatment of CCFs can be provided in a medium-volume neurovascular center.