6th Edition of Neurology World Conference 2026

Abstract

Purpose: Carotid-cavernous fistula (CCF) is an anomalous connection between the internal carotid artery and the cavernous sinus. Limited investigation facilities, lack of awareness, delayed diagnosis & treatment adversely affect the outcome of CCF. This study aims to evaluate the outcomes of endovascular treatment for indirect carotid-cavernous fistula (CCF) in a case series from Bangladesh. Materials and Methods: This retrospective case series included 15 patients with indirect CCF (Barrow types B, C, and D) treated with endovascular embolization between 2019 and 2024 at the National Institute of Neurosciences & Hospital (NINS), Dhaka. Data on demographics, etiology, clinical presentation, angiographic findings, treatment approaches, embolic materials, and outcomes were collected and analyzed. Treatment was performed through arterial, venous, or combined approaches based on fistula anatomy and procedural feasibility. Clinical and angiographic follow-up assessments were conducted at least six-months post-procedure where available. Results: The median age was 50 years with the range: 24–69 years, of whom 73.3% were female. Prior admission 66.7% had spontaneous etiology where proptosis was the most common presenting symptom (73.3%), followed by headache (20.0%) and ocular pain (20.0%). Thus, 53.3% had received ophthalmic treatment before. The transarterial approach was most frequently used (86.7%), where transvenous and combined arterial-venous approaches in 6.7% of cases. Embolization was performed using N-butyl cyanoacrylate (NBCA), ethylene vinyl alcohol copolymer (EVOH), polyvinyl alcohol (PVA) particles, or combination therapy depending on fistula characteristics. Postoperative angiography demonstrated complete obliteration in 93.3% of patients. Clinically, significant improvement was observed in 80.0% of patients during follow-up. A post-procedural complication of vision loss occurred in one patient (6.7%) only. Conclusion: Despite infrastructural and economic limitations, the use of endovascular management with EVOH and NBCA has demonstrated favorable outcomes in indirect CCF patients. Improved awareness, early diagnosis, and prompt referral systems are essential to enhance CCF care in low-resource settings. Keywords: Carotid-cavernous fistula, Indirect CCF, Endovascular embolization, Interventional neurology