title: Follow-up of endovascular treatment of direct carotid-cavernous fistulas.
abstract: BACKGROUND
  Direct carotid-cavernous fistula (CCF) is a direct communication between the internal carotid artery (ICA) and the cavernous sinus. Some patients treated with detachable balloons develop pseudoaneurysms or present with a true aneurysm recanalization in the cavernous ICA with poorly known long-term radiological and clinical progression. The objective of the present study was to evaluate the long-term clinical and radiological progression of patients treated with detachable balloons.
  
  
  METHODS
  The present study evaluated 13 patients previously treated for direct CCF by an endovascular approach.
  
  
  RESULTS
  The follow-up period ranged between 19 and 128 months. Ophthalmological evaluation demonstrated alterations in eight patients (61.5%). All of these alterations were already present from the moment of the treatment and displayed no signs of progression. Cranial magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed in all patients, and 11 pseudoaneurysms were demonstrated in ten of the 11 patients in whom ICA patency had been preserved. Five patients were submitted for cerebral digital subtraction angiography (DSA) to characterize the pseudoaneurysms previously observed on MRA studies, with no significant differences in morphology, size, aneurismal neck, and number of lesions.
  
  
  CONCLUSIONS
  Endovascular treatment of direct CCF with detachable balloons has been shown to be a long-term effective and stable therapeutic method. The authors found asymptomatic pseudoaneurysms in 91% of cases where the ICA patency was preserved. MRI and MRA demonstrated an accuracy similar to that of DSA in the diagnosis of pseudoaneurysms of cavernous ICA.
authors.affiliation: Department of Radiology, Federal University of São Paulo, Rua Napoleão de Barros, 800, São Paulo, SP, Brazil.
authors.forename: Márcio C Pedro
authors.initials: MC
authors.lastname: Marques
authors.forename: José Guilherme M Pereira
authors.initials: JG
authors.lastname: Caldas
authors.forename: Dárcio R
authors.initials: DR
authors.lastname: Nalli
authors.forename: Jose Roberto F
authors.initials: JR
authors.lastname: Fonseca
authors.forename: Roberto G
authors.initials: RG
authors.lastname: Nogueira
authors.forename: Nitamar
authors.initials: N
authors.lastname: Abdala
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000628:therapy*; D021721:Balloon Occlusion / Q000379:methods*; D002339:Carotid Arteries / Q000002:abnormalities* / Q000473:pathology*; D002426:Cavernous Sinus / Q000002:abnormalities* / Q000473:pathology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
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