Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla, Sankara Nethralaya (A Unit of Medical Research Foundation, Chennai), Kolkata, India.
Orbit. 2023 Oct;42(5):502-509. doi: 10.1080/01676830.2022.2136203. Epub 2022 Oct 26.
To evaluate the efficacy of intermittent manual carotid compression (IMCC) in the management of low-flow carotid cavernous fistulae (CCF).
Patients diagnosed with low-flow CCF and treated with IMCC over a period of 13 years were retrospectively analyzed. Data analyzed included demographic details, clinical features, type of CCF, and response to therapy. Outcomes were categorized as complete cure, partial cure, and no cure or worsening. Patients with complete and partial cure were grouped as good outcome whereas those with no cure or worsening as poor outcome.
A total of 44 patients were advised IMCC for low-flow CCF, of whom five were lost to follow-up. Results of the remaining 39 patients were analyzed, of whom 21 (53.8%) were males. The mean age at presentation was 54.38 ± 14.54 years. The median duration between the onset of symptoms and presentation was 5.0 ± 4.10 months. The common presenting features were episcleral congestion and proptosis (89.7%), extraocular motility restriction (66.7%), and diplopia (48.7%). Most common CCF type was type D (34, 87.2%). All patients were advised to undergo IMCC. Good outcome was seen in 35 patients (89.7%, 95% CI: 80.2% to 99.2%), whereas poor outcome was seen in four (10.3%) patients. The mean duration of follow-up was 15.91 ± 21.87 months.
The present study found a good outcome with IMCC in 89.7% cases of indirect low-flow CCF with no major complications. It should be considered the management of choice in patients who are systemically unfit or cannot afford endovascular embolization.
评估间歇性手动颈动脉压迫（IMCC）在治疗低流量颈动脉海绵窦瘘（CCF）中的疗效。
回顾性分析了 13 年来接受 IMCC 治疗的低流量 CCF 患者。分析的数据包括人口统计学细节、临床特征、CCF 类型以及对治疗的反应。结果分为完全治愈、部分治愈和无治愈或恶化。完全和部分治愈的患者归为良好结局，而无治愈或恶化的患者归为不良结局。
共有 44 例低流量 CCF 患者接受了 IMCC 治疗，其中 5 例失访。对其余 39 例患者的结果进行了分析，其中 21 例（53.8%）为男性。发病时的平均年龄为 54.38±14.54 岁。症状出现到就诊的中位时间为 5.0±4.10 个月。常见的表现是眼巩膜充血和突出（89.7%）、眼外肌运动受限（66.7%）和复视（48.7%）。最常见的 CCF 类型是 D 型（34 例，87.2%）。所有患者均建议行 IMCC。35 例（89.7%，95%CI：80.2%至 99.2%）患者获得良好结局，4 例（10.3%）患者结局不良。平均随访时间为 15.91±21.87 个月。
本研究发现，在 89.7%的间接低流量 CCF 患者中，IMCC 治疗效果良好，且无重大并发症。对于全身状况不佳或无法接受血管内栓塞治疗的患者，应将其作为治疗选择。
