{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:00:22Z","timestamp":1790694022569,"version":"4.1.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T00:00:00Z","timestamp":1718582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["NS065743"],"award-info":[{"award-number":["NS065743"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Interv Neuroradiol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Carotid-cavernous fistulas (CCFs) are complex arteriovenous shunting lesions of the cavernous sinus with diverse clinical presentations. This study aimed to analyze clinical outcomes and differentiate patients treated with conservative observation versus those needing endovascular intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 84 patients with angiographically confirmed CCF was conducted from 2000 to 2022. Endovascular treatment decisions were made at the discretion of neurointerventionalists. Clinical and angiographic data were collected, including Barrow CCF classification and treatment outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients managed conservatively (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200917) had longer symptom duration (165 vs 42 days) and more indirect CCF (100% vs 68%) compared to those treated with endovascular embolization (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200967). High-risk clinical symptoms, including proptosis, diplopia, decreased visual acuity, and chemosis, were more common in the embolization group. Cortical venous reflux and ophthalmic venous reflux were more prevalent in the embolization group (39% and 91%, respectively). Overall, 31% of embolized CCFs required retreatment, mainly Barrow type D lesions (65%). Transvenous coil embolization was the primary technique used (78%), followed by feeder artery embolization (16%), and internal carotid artery flow diversion (8%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In selected CCF patients without high-risk symptoms or angiographic features, conservative observation is a safe and effective alternative to endovascular embolization. High-risk symptoms and angiographic features favor endovascular intervention. Complications were rare, and most were transient, emphasizing the safety of endovascular management. Longitudinal angiographic and ophthalmologic surveillance is essential for monitoring fistula persistence or recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15910199241261761","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T03:57:51Z","timestamp":1718596671000},"page":"2088-2095","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Endovascular and medical management strategies for carotid-cavernous fistulas: A safety and efficacy analysis"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6000-6709","authenticated-orcid":false,"given":"Justin E.","family":"Vranic","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital"},{"name":"Department of Radiology, Massachusetts General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Regenhardt","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital"},{"name":"Department of Neurology, Massachusetts General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3396-583X","authenticated-orcid":false,"given":"Amine","family":"Awad","sequence":"additional","affiliation":[{"name":"Department of Neurology, Massachusetts General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Doron","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Rabinov","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital"},{"name":"Department of Radiology, Massachusetts General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,17]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.012784"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1985.62.2.0248"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/197140091202500117"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuri.2022.100047"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318154c9fb"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1981.00790410045012"},{"key":"e_1_3_2_8_2","first-page":"185","article-title":"Ruptured cavernous sinus aneurysms causing carotid cavernous fistula: incidence, clinical presentation, treatment, and outcome","volume":"27","author":"Van Rooij WJ","year":"2006","unstructured":"Van Rooij WJ, Sluzewski M, Beute GN. 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