Carotid artery cavernous fistulas

The treatment of carotid cavernous fistulas has undergone a fundamental transformation during the preceding 30 years. Endovascular techniques have not only largely replaced surgical management of this disease, but have also resulted in substantially lower rates of procedure-associated morbidity and mortality. Percutaneous transarterial occlusion of direct cavernous carotid fistulas with preservation of the carotid artery using detachable balloons is now considered the current preferred therapeutic objective. Concurrent progress in percutaneous transvenous embolization techniques and materials has led to more effective and better-tailored therapies for indirect (dural) carotid cavernous fistulas. The current understanding of the clinicopathologic mechanisms associated with carotid cavernous fistulas and the endovascular therapies used in the contemporary management of this condition are reviewed.