title: Endovascular treatment of direct carotid cavernous fistulae: a pictorial review.
abstract: BACKGROUND
  Direct carotid-cavernous fistulae (CCFs) are type A fistulae according to Barrow's classification. Endovascular treatment of these lesions is challenging.
  
  
  METHODS
  The purpose of this review was to evaluate the endovascular treatment of direct CCFs. We also describe the technique, symptomatology and complications associated with the procedure and report on the long-term follow-up in our treated patients.
  
  
  RESULTS
  A total of 89 patients with a direct CCF were treated. All patients had baseline brain CT or MR imaging. Treatment comprised transarterial balloon or coil embolizations. The patients were followed up at 1 month and then every 6 months thereafter. Detachable balloons were used in 79 fistulae. In 12 fistulae the balloon could not be negotiated through the fistula and these fistulae were treated with transarterial coil occlusion. Clinical outcomes of the treated patients evaluated at 1 month were: 79 patients (88.8%) cured, 9 (10.1%) significantly improved, 1 (1.1%) remaining static.
  
  
  CONCLUSIONS
  Endovascular treatment of direct CCFs is safe and effective and results in long-term cure.
authors.affiliation: Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, India. gupta209@yahoo.com
authors.forename: Arun K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Sukalyan
authors.initials: S
authors.lastname: Purkayastha
authors.forename: T
authors.initials: T
authors.lastname: Krishnamoorthy
authors.forename: Narendra K
authors.initials: NK
authors.lastname: Bodhey
authors.forename: T R
authors.initials: TR
authors.lastname: Kapilamoorthy
authors.forename: C
authors.initials: C
authors.lastname: Kesavadas
authors.forename: Bejoy
authors.initials: B
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D017130:Angioplasty; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis* / Q000628:therapy*; D002533:Cerebral Angiography; D002648:Child; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome