{
  "abstract": "Introduction Carotid-cavernous fistulas (CCFs) are uncommon arteriovenous shunts that can present with a wide range of non-specific ophthalmic and neurological symptoms, often leading to diagnostic delays. While endovascular embolization is the primary treatment modality, data on long-term functional outcomes and the prognostic value of baseline symptom burden remain limited.Methods We conducted a retrospective single-center cohort study of consecutive patients with angiographically confirmed CCFs treated with endovascular embolization between 2009 and 2025. Clinical outcomes were assessed at early follow-up (median 1.5 months) and long-term follow-up (>1 year; median 52 months). Logistic regression analyses were used to evaluate the association between symptom burden, angiographic occlusion status, and failure of clinical improvement.Results A total of 107 patients were included (median age: 64 years, 35% male). Diagnostic delays were common (median duration from symptom onset to treatment: 30 days), frequently due to misdiagnosis as inflammatory, infectious, or vascular orbital conditions. Early follow-up demonstrated complete or partial improvement in 91% of patients, with significant progression from partial to complete improvement at long-term follow-up (p = 0.001). Complication and repeat treatment rates were low. Neither symptom duration nor number of presenting symptoms was associated with failure of improvement at early or long-term follow-up (p ≥ 0.05). Complete angiographic obliteration at the end of the procedure was associated with improved early outcomes (OR 0.09; 95% CI 0.02-0.39), while complete occlusion at last radiological follow-up predicted favorable long-term outcomes (OR 0.15; 95% CI 0.02-0.94).Conclusions Endovascular embolization of CCFs is associated with excellent clinical outcomes and sustained long-term improvement. Symptom burden and diagnostic delays did not predict post-treatment recovery, whereas durable angiographic occlusion was a key determinant of outcome. These findings support intervention even in patients presenting late and emphasize the importance of achieving complete fistula occlusion.Disclosures V. El-Hajj: None. M. Gharios: None.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "V El-Hajj"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "M Gharios"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University, Philadelphia, PA"
      ],
      "name": "J Roy"
    },
    {
      "affiliations": [
        "Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "B Musmar"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "S Tjoumakaris"
    },
    {
      "affiliations": [
        "Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "M Gooch"
    },
    {
      "affiliations": [
        "Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "P Jabbour"
    }
  ],
  "title": "E-245 Long-term recovery trajectories following endovascular treatment of carotid-cavernous fistulas, a single-center cohort study",
  "uid": "ff754f83-e116-52eb-8e7f-744d43df3e4e"
}