Patch technique using flow diverters effective in treating direct carotid-cavernous fistula symptoms

This case series included three patients with a history of trauma who presented with decreased visual acuity, cranial nerve II deficit, limited extraocular muscles' movement, and increased intraocular pressure (IOP). Diagnostic angiography confirmed high-flow Type A CCF, and endovascular treatment was performed through distal radial (2 patients) and femoral access (1 patient) by deploying four sequentially enlarging PEDs with immediate resolution of ocular symptoms. Follow-up angiography showed complete resolution in two patients. In contrast, the third patient who lost to follow-up had residual small CCF demonstrated by angiogram at four months with significant improvement from postprocedure angiogram.

The patch technique with sequentially enlarging FDs can be considered a suitable solo technique for addressing symptoms of CCF and lead to the immediate resolution of CVR without causing harm to the cavernous sinus's anatomy. The technique preserves the anatomy of cavernous sinus.

Reference:

Al-Smadi et al. Patch Technique for Primary Treatment of Type A Carotid Cavernous Fistula: A Case Series and Technical Notes. Journal of Neuro-Ophthalmology 43(4):p 541-546, December 2023.