Intermittent manual compression for CCF
Reviewed by Hetvi Bhatt

Carotid cavernous fistulae (CCF) can be classified as high and low-flow or as having direct and indirect communication. Most commonly, management of high-flow CCF is with endovascular embolisation. The authors look at an alternative treatment for CCF in indirect low-flow types in the form of intermittent manual carotid compression (IMCC). Thirty-nine patients were included. The most common presenting features were proptosis and episcleral congestion (89.7%). The authors report that 35 patients had a good outcome with 19 having complete cure and 16 a partial cure. Interestingly, the mean time to diagnosis was 5.01 ± 4.10 months, with the longest time being 18 months. An important finding is that 12.8% (n=5) of patients developed superior ophthalmic vein thrombosis following IMCC and the intervention was stopped whilst the patients were given anti-coagulation. Four patients were able to restart IMCC and all five patients had a good outcome. This study shows a much higher success rate of IMCC compared to other studies and demonstrates that this type of intervention may have a role in health care systems where there is limited access to interventional radiology. We should be wary of the complications however, and should also remember that some low-flow CCF may spontaneously resolve and only require observation.

Intermittent Manual Carotid Compression as a Treatment Option for Indirect Low Flow Carotid Cavernous Fistula.
Koka K, Alam MS, Halbe S, et al.
ORBIT
2023;42(5):502–9.