In recent 15 years endovascular approach has been a primary treatment of direct carotidocavernous fistulas (CCFs). Our retrospective study has analyzed 12-years’ experience in the series of 31 patients with CCF. The treatment strategy in the series presented was modified by technical advances in endovascular techniques. At the beginning, detachable balloons were used (in 35 %), and recently there have been exclusively used coils (in 52 %) for easier manipulation. The aim of treatment is a selective fistula closure with preserving the patency of the internal carotid artery (ICA), but it has not always turned out well. 48 endovascular surgeries were carried out. Selectively, CCFs were closed successfully in 58 % with preserving the patency of the ICA. The fistula anatomy and technical possibilities of the treatment forced us to close the ICA together with a fistula in 42 % cases without clinical ischemic manifestations. Clinical disorders of patients were improved in 77 % of the treated. A serious complication of the therapy was fatal bleeding from the ICA in one patient during an endovascular surgery, in whom Ehlers Danlos syndrome was proved.

        Key words: direct carotidocavernous fistulas, endovascular treatment, Ehlers Danlos syndrome