Dural carotid cavernou fitula: definitive endovacular management and long-term follow-up

PURPOE: To decribe the endovacular treatment and clinical outcome in patient with indirect carotid cavernou fitula (CCF) over a 15-year period. To our knowledge, thi i the larget erie in the medical literature. DEIGN: Interventional cae erie. METHOD: A retropective evaluation of 135 conecutive patient who underwent examination and treatment for indirect CCF wa performed. Patient received independent evaluation by ophthalmologit, neurologit, or neuro-ophthalmologit before, during, and after endovacular treatment. Patient initially received noninvaive imaging followed by cerebral arteriography for definitive diagnoi and tratification by angiographic rik factor. Endovacular treatment wa performed in 133 (98%) patient and clinical follow-up wa achieved in 135 (100%) patient on an average of 56 ± 4.3 month (range: 2 month–14 year). Angiographic follow-up wa performed in 72 (54%) patient with ongoing ymptom or a hitory of fitula with high-rik angiographic feature. Arteriographic cure with long-term clinical outcome i ummarized by modified Rankin cale (mR) and Barthel index (BI). REULT: At a mean follow-up of 56 month, 121 (90%) patient were clinically cured. At latet clinical follow-up, 131 (97%) patient howed good recovery (mR, 1–2; BI 90–100), one (1%) had moderate diability (mR, 3; BI, 50–60), and three (2%) (mR, 4; BI, 40–50) were everely diabled. Procedure-related permanent morbidity wa 2.3%. There wa no operative mortality. CONCLUION: With the oberved favorable outcome and low rate of procedural morbidity in thi patient population with long-term angiographic and clinical follow-up, endovacular therapy hould be the primary treatment for patient with indirect (dural) fitula of the cavernou inu.