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Transvenous embolization of dural carotid cavernous fistulas: the role of liquid embolic agents in association with coils on patient outcomes
  1. Luís Henrique de Castro-Afonso1,
  2. Felipe Padovani Trivelato2,
  3. Marco Túlio Rezende2,
  4. Alexandre Cordeiro Ulhôa2,
  5. Guilherme Seizem Nakiri1,
  6. Lucas Moretti Monsignore1,
  7. Benedicto Oscar Colli3,
  8. Antônio Augusto Velasco-e-Cruz4,
  9. Daniel Giansante Abud1
  1. 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
  2. 2 Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
  3. 3 Division of Neurosurgery, Department of Surgery, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
  4. 4 Department of Ophthalmology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
  1. Correspondence to Dr Luís Henrique de Castro-Afonso, Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; ikeafonso{at}


Introduction Transvenous embolization is the standard treatment for dural carotid cavernous fistulas (DCCF). Although various embolic materials have been used, the best embolic material for the treatment of DCCF is still unknown.

Objective To assess the safety and efficacy of different embolic materials used for the endovascular treatment of DCCF.

Methods A retrospective data analysis of a consecutive series of 62 patients presenting DCCF was performed. Clinical and radiological data from patients were assessed, and the embolic material used—coils or liquids—were compared between two groups of patients.

Results Complete angiographic occlusion of DCCF after treatment was achieved in 83.9% of the patients (52/62). We found a higher rate of complete occlusion of DCCF when liquids were associated with coils than with coils alone (96.5% vs 71.8%, p=0.01), and no differences in complication rates or clinical outcomes were seen between the two groups. At the 6-month follow-up, we found a higher rate of improvement in ocular symptoms compared with cranial nerve palsy improvement (94.7% vs 77.7%, p=0.02). Two patients (3.2%) had treatment-related complications without clinical symptoms.

Conclusion In this study, in comparison with the use of coils alone, the association of transvenous embolization with liquid embolic agents for DCCF treatment resulted in higher rates of complete occlusion without increasing complication rates. The clinical outcome at the 6-month follow-up showed significant improvement in ocular symptoms over cranial nerve palsy regression, which was independent of the embolic agent chosen for treatment.

  • dural carotid cavernous fistula
  • embolization
  • coils
  • onyx

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  • Contributors LHC-A helped to conceive the study, drafted and approved the manuscript; FPT helped to conceive the study and design, carried out data analysis, revision, and gave final approval of the manuscript; MTR, ACU GSN, LMM, BOC, AAVeC participated in data acquisition, editing of figures and tables , revision, and final approval of the manuscript; DGA conceived the study, acquired data, revised the manuscript critically, and approved the final manuscript.

  • Competing interests None declared.

  • Ethics approval Ethics committee and review board of the institution.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished or unprocessed data, protocols, or images are available upon request from the corresponding author.