Nurimanov Chingiz, Mammadinova Iroda, Menlibayeva Karashash, Kydyrmoldin Yeldar, Duisengali Ramazan, Kerimbayeva Diana, Akshulakov Serik, Makhambetov Yerbol
Department of Vascular and Functional Neurosurgery, National Center of Neurosurgery, Astana, Kazakhstan.
Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Front Neurol. 2025 Aug 26;16:1625899. doi: 10.3389/fneur.2025.1625899. eCollection 2025.
Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and/or its branches and the cavernous sinus, potentially resulting in significant complications, including visual impairment and neurological deficits. Timely diagnosis and appropriate therapeutic intervention are critical to minimizing the risk of adverse outcomes. Over the years, endovascular techniques have become the preferred method for treating CCFs, offering high success rates with fewer complications. This study aims to study the clinical and radiological outcomes of patients with CCFs treated with endovascular approaches, and to identify key prognostic factors associated with treatment efficacy and symptomatic resolution.
A retrospective analysis was conducted of patients diagnosed with carotid-cavernous fistulas (CCFs) and treated at the National Center for Neurosurgery in Astana, Kazakhstan, between 2008 and 2024. A total of 71 patients underwent endovascular embolization using either transarterial or transvenous techniques. According to the Barrow classification, type A CCF were observed in 62 patients (87.3%), type D in 7 patients (9.9%), and types B and C in 1 patient each (1.4%). Collected data included patient demographics, type of embolic materials utilized, number of procedures performed, treatment approach, and corresponding radiological and clinical outcomes.
Among the 71 patients included in the study, 80.3% achieved complete clinical resolution, 15.5% demonstrated partial improvement, and 4.2% experienced no clinical benefit. The mean age was 35.7 ± 12.9 years, with 71.8% males. Clinical outcomes were significantly associated with complete occlusion following the initial intervention ( < 0.001), with 96% of these patients achieving full symptom resolution. Imaging follow-up was available in all patients, with complete occlusion confirmed in 65 cases (91.5%) on MRI at 6 months. Other variables, including distal internal carotid artery flow ( = 0.145), number of interventions ( = 0.838), treatment approach ( = 0.529), and type of embolic agent employed ( = 0.778), did not demonstrate a statistically significant association with clinical outcomes.
Endovascular embolization is a safe and effective first-line treatment modality for CCFs. Both transarterial and transvenous approaches offer comparable rates of clinical success. Achieving complete occlusion is a critical determinant of favorable clinical outcomes and is associated with a reduced risk of treatment-related complications.
颈动脉海绵窦瘘（CCF）是颈动脉及其分支与海绵窦之间的异常连接，可能导致严重并发症，包括视力损害和神经功能缺损。及时诊断和适当的治疗干预对于将不良后果的风险降至最低至关重要。多年来，血管内技术已成为治疗CCF的首选方法，成功率高且并发症较少。本研究旨在探讨采用血管内方法治疗CCF患者的临床和影像学结果，并确定与治疗效果和症状缓解相关的关键预后因素。
对2008年至2024年期间在哈萨克斯坦阿斯塔纳国家神经外科中心诊断为颈动脉海绵窦瘘（CCF）并接受治疗的患者进行回顾性分析。共有71例患者采用经动脉或经静脉技术进行了血管内栓塞。根据巴罗分类，62例患者（87.3%）为A型CCF，7例患者（9.9%）为D型，B型和C型各1例（1.4%）。收集的数据包括患者人口统计学资料、所用栓塞材料类型、手术次数、治疗方法以及相应的影像学和临床结果。
在纳入研究的71例患者中，80.3%实现了临床完全缓解，15.5%有部分改善，4.2%未从临床治疗中获益。平均年龄为35.7±12.9岁，男性占71.8%。临床结果与初次干预后完全闭塞显著相关（<0.001），其中96%的患者症状完全缓解。所有患者均进行了影像学随访，6个月时MRI证实65例（91.5%）完全闭塞。其他变量，包括颈内动脉远端血流（=0.145）、干预次数（=0.838）、治疗方法（=0.529）和所用栓塞剂类型（=0.778），与临床结果均无统计学显著关联。
血管内栓塞是治疗CCF的一种安全有效的一线治疗方式。经动脉和经静脉方法的临床成功率相当。实现完全闭塞是良好临床结果的关键决定因素，并且与治疗相关并发症风险降低相关。
