The clinical features, angiographic and endovascular treatment of indirect carotid cavernous fistulas

Indirect carotid cavernous fistulas (ICCFs) are rare disease entities triggered by indirect low flow between the cavernous sinus and the meningeal branches of the internal or external carotid artery or from both. To evaluate clinical characteristics, angiography, and relationship to the result of endovascular treatment of indirect carotid cavernous fistulas. A prospective study of 32 patients diagnosed to identify ICCFs through digital subtraction angiography (DSA) and intravascular intervention. Results showed that indirect carotid cavernous fistulas were more common in females of advanced age (68.8%) and occurred spontaneously (87.5%); the most common symptoms included chemosis (93.75%), headache (87.5%), proptosis (53.1%), and tinnitus (37.5%) with type D being the most common (81.2%). Thirty out of thirty-two patients with intervention had complete flow block (83.3%), near complete (13.3%), and failure in one case. Incomplete occlusion interventions and failures were of the type D complication. The complication and number of drainage veins are related (p<0.05). ICCFs have diverse symptoms that depend on the drainage veins but most commonly were red eyes, headache, and protruding eyes. The ICCFs were mostly D-type formation and endovascular treatments were safe and effective. Common complications occurred in the case of many veins draining.