title: Transarterial treatment of direct carotico-cavernous fistulas with coils and Onyx.
abstract: BACKGROUND
  The purpose of this study was to evaluate the role of combination of liquid embolic agent ethylene vinyl alcohol copolymer (Onyx) and detachable coils in the treatment of direct carotico-cavernous fistulas (CCFs).
  
  
  METHODS
  We prospectively collected clinical and radiological data of all patients who underwent embolization of direct CCFs at our institution over a period of 21 months. The clinical parameters, angioarchitecture, presence of cortical venous reflux, volume of Onyx used, number of coils used, extent of embolization and complications were recorded.
  
  
  RESULTS
  A total of 21 consecutive patients (18 men and 3 women, 14 to 48 years) with direct CCF underwent embolization with a combination of coils and Onyx. Embolization was done through the arterial route in all cases. Complete obliteration of the fistula was achieved in 19 of 21 cases. Cast embolization in middle cerebral artery occurred in one patient; however, the cast was completely retrieved with Solitaire device, and the patient did not have any neurological deficit. All completely treated patients reported relief of symptoms at varying intervals. At 6-month follow-up, none of the patients with complete occlusion of the fistula showed any recurrence.
  
  
  CONCLUSIONS
  The adjuvant use of Onyx with detachable coils in direct CCF through the arterial route is a safe and effective method for embolization with immediate and complete occlusion of the fistula. To the best of our knowledge, this is the first case series of demonstration of arterial use of Onyx with coils in the treatment of direct CCFs.
authors.affiliation: Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India, aravind.radiology@gmail.com.
authors.forename: Arvinda Hanumanthapura
authors.initials: AH
authors.lastname: Ramalingaiah
authors.forename: Chandrajit
authors.initials: C
authors.lastname: Prasad
authors.forename: Paramveer Singh
authors.initials: PS
authors.lastname: Sabharwal
authors.forename: Jitender
authors.initials: J
authors.lastname: Saini
authors.forename: Paritosh
authors.initials: P
authors.lastname: Pandey
mesh_terms: D000293:Adolescent; D000328:Adult; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis* / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide