Endovascular treatment demonstrates high efficacy in managing direct carotid cavernous fistulas (CCFs). This report discusses a series of four cases of CCF to evaluate their ocular manifestations and effectiveness of endovascular treatment. The most common presenting symptoms were proptosis, chemosis, and redness of the affected eye. Endovascular approaches included coil embolization, balloon occlusion, and liquid embolic agent techniques. Complete angiographic occlusion was achieved, and symptomatic improvement was found in all the cases after the initial procedure. Patients were followed for at least 6 months, with evaluations at 1 week, 1 month, 3 months, and 6 months. Final outcomes were assessed angiographically at 6 months. Endovascular treatment offers a highly effective and safe approach for managing direct CCFs. Prompt diagnosis and individualized treatment strategies are critical for optimal clinical and radiological outcomes.

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S.K.S. and M.K.N. contributed to conceptualization, writing of the original manuscript (lead, equal), investigation, data curation, software, and visualization; C.D., R.V.R., and C.R.M. contributed to writing (review and editing), supervision, visualization, validation, and data curation. S.K.S. supervised the overall study, and all authors contributed substantially to the manuscript.

Article published online:
01 May 2026

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