DSA-Dynavision in pretreatment planning for coil embolization of indirect carotid-cavernous fistula.

Abstract

Indirect carotid cavernous fistulas are treated with coil embolization when they present with orbital/visual symptoms or if there is cortical venous reflux. Most of the time, the treatment is done by non-specifically packing the whole cavernous sinus with coils. The purpose of this case series was to examine whether DSA-Dynavision before embolization would improve treatment by shortening the procedure time, requiring fewer coils, or reducing the complication rate. 8 patients with 9 fistula sites were retrospectively identified. DSA-Dynavision and non-DSA-Dynavision patients were compared in a retrospective cohort study. Mean total coil length was significantly shorter for the group who had DSA-Dynavision than for those who had non-DSA-Dynavision (130.5 cm vs 190 cm, p=0.034) and mean procedural time was significantly shorter for the DSA-Dynavision group (171.1 min vs 280.3 min, p=0.025). A transient neurological complication was seen in only one patient. The use of DSA-Dynavision in pre-procedural planning facilitates selective coil embolization of the foot of the vein.