Detachable Balloon Embolization As the Preferred Treatment Option for Traumatic Carotid-cavernous Sinus Fistula?

Overview

Journal Interv Neuroradiol

Publisher Sage Publications

Specialty Neurology

Date 2019 Aug 28

PMID 31451026

Citations 7

Authors

Yin Niu

Tunan Chen

Jun Tang

Zhouyang Jiang

Gang Zhu

Zhi Chen

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of the study was to investigate the treatments and outcomes of patients with traumatic carotid-cavernous sinus fistula (TCCF).

Methods: All patients diagnosed with TCCF at our institution from January 2013 to December 2018 and meeting the inclusion/exclusion criteria were included in the study.

Results: A total of 24 patients were included in this study. Of them, 21 (87.5%) were treated with detachable balloon embolization, 1 (4%) with coil embolization, 1 (4%) with balloon-assisted coil embolization, and 1 (4%) with balloon-assisted coil and glue embolization. Among the 21 patients treated with detachable balloon embolization, 10 underwent double-balloon technique embolization including double-detachable balloon embolization (n = 6) and balloon-assisted detachable balloon embolization (n = 4). The fistulas in 17 patients (17/21, 81%) were successfully occluded after the first attempt of detachable balloon embolization, while those in the remaining 4 patients were occluded after a second surgery due to TCCF recurrence or pseudoaneurysm development. Preservation of the internal carotid artery (ICA) was observed in 19 cases after the first treatment by detachable balloon embolization (19/21, 90.4%). ICA was occluded in the remaining two patients, as revealed by a complete angiographic evaluation of the circle of Willis. All patients achieved complete resolution of ocular and orbital manifestations as well as pulsatile bruit, except for three patients whose oculomotorius and/or abducens remained paralyzed during the follow-up period.

Conclusion: Although several endovascular treatment options are available for TCCF, the detachable balloon embolization is still the preferred method of TCCF, as evidenced in our study. Furthermore, double balloon technique, an improvement upon the conventional detachable balloon embolization, is extremely safe and can effectively treat patients with refractory TCCF.

Citing Articles

Part 2: The development and advancement of the detachable balloon catheter; a historical and technical review.

Madapoosi A, Sanchez-Forteza A, Mrad T, McGuire L, Theiss P, Tshibangu M Interv Neuroradiol. 2024; :15910199241272531.

PMID: 39109631 PMC: 11571430. DOI: 10.1177/15910199241272531.

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study.

Iampreechakul P, Wangtanaphat K, Chuntaroj S, Wattanasen Y, Hangsapruek S, Lertbutsayanukul P World J Radiol. 2024; 16(4):94-108.

PMID: 38690547 PMC: 11056853. DOI: 10.4329/wjr.v16.i4.94.

Aneurysm Isolation is Associated with Complete Occlusion of Aneurysms After Flow Diverter Treatment.

Fujitani S, Tsuruta W, Tomioka A, Ishigami D, Sekine T, Hosoo H Clin Neuroradiol. 2023; 33(4):1087-1093.

PMID: 37428198 DOI: 10.1007/s00062-023-01312-z.

Clinical efficacy of endovascular treatment approach in patients with carotid cavernous fistula: A systematic review and meta-analysis.

Rahmatian A, Yaghoobpoor S, Tavasol A, Aghazadeh-Habashi K, Hasanabadi Z, Bidares M World Neurosurg X. 2023; 19:100189.

PMID: 37223772 PMC: 10200966. DOI: 10.1016/j.wnsx.2023.100189.

Case report: emergent endovascular treatment for carotid cavernous fistulas presenting as intracranial hemorrhage.

Li Z, Chen A, Chen Y, Yang D, Wan Y, Wu Y Front Neurol. 2023; 14:1133259.

PMID: 37143994 PMC: 10151811. DOI: 10.3389/fneur.2023.1133259.

References

DEBRUN G, Lacour P, Vinuela F, Fox A, Drake C, Caron J . Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg. 1981; 55(5):678-92. DOI: 10.3171/jns.1981.55.5.0678. View

Lang M, Habboub G, Mullin J, Rasmussen P . A brief history of carotid-cavernous fistula. J Neurosurg. 2016; 126(6):1995-2001. DOI: 10.3171/2016.5.JNS152372. View

Moron F, Klucznik R, Mawad M, Strother C . Endovascular treatment of high-flow carotid cavernous fistulas by stent-assisted coil placement. AJNR Am J Neuroradiol. 2005; 26(6):1399-404. PMC: 8149099. View

Gomez F, Escobar W, Gomez A, Gomez J, Anaya C . Treatment of carotid cavernous fistulas using covered stents: midterm results in seven patients. AJNR Am J Neuroradiol. 2007; 28(9):1762-8. PMC: 8134221. DOI: 10.3174/ajnr.A0636. View

Teng M, Chang C, Chiang J, Lirng J, Luo C, Chen S . Double-balloon technique for embolization of carotid cavernous fistulas. AJNR Am J Neuroradiol. 2000; 21(9):1753-6. PMC: 8174863. View

He X, Li W, Peng W, Lu J, Liu Q, Zhao R . Endovascular treatment of posttraumatic carotid-cavernous fistulas and pseudoaneurysms with covered stents. J Neuroimaging. 2013; 24(3):287-91. DOI: 10.1111/jon.12023. View

Briganti F, Tortora F, Marseglia M, Napoli M, Cirillo L . Covered Stent Implantation for the Treatment of Direct Carotid-Cavernous Fistula and Its Mid-Term Follow-up. Interv Neuroradiol. 2010; 15(2):185-90. PMC: 3299020. DOI: 10.1177/159101990901500208. View

Lewis A, Tomsick T, TEW Jr J . Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons. Neurosurgery. 1995; 36(2):239-44; discussion 244-5. DOI: 10.1227/00006123-199502000-00001. View

Higashida R, Halbach V, Tsai F, Norman D, PRIBRAM H, Mehringer C . Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases. AJR Am J Roentgenol. 1989; 153(3):577-82. DOI: 10.2214/ajr.153.3.577. View

10.

van Rooij W, Sluzewski M, Beute G . Ruptured cavernous sinus aneurysms causing carotid cavernous fistula: incidence, clinical presentation, treatment, and outcome. AJNR Am J Neuroradiol. 2006; 27(1):185-9. PMC: 7976066. View

11.

Choi B, Lee T, Kim C, Choi C . Endovascular graft-stent placement for treatment of traumatic carotid cavernous fistulas. J Korean Neurosurg Soc. 2010; 46(6):572-6. PMC: 2803275. DOI: 10.3340/jkns.2009.46.6.572. View

12.

Wang Z, Ding X, Zhang J, Qu C, Wang C, Huang D . HydroCoil occlusion for treatment of traumatic carotid-cavernous fistula: preliminary experience. Eur J Radiol. 2008; 71(3):456-60. DOI: 10.1016/j.ejrad.2008.06.009. View

13.

Marques M, Caldas J, Nalli D, Fonseca J, Nogueira R, Abdala N . Follow-up of endovascular treatment of direct carotid-cavernous fistulas. Neuroradiology. 2010; 52(12):1127-33. DOI: 10.1007/s00234-010-0683-8. View

14.

Kalia J, Niu T, Zaidat O . The use of a covered stent graft for obliteration of high-flow carotid cavernous fistula presenting with life-threatening epistaxis. J Neurointerv Surg. 2011; 1(2):142-5. DOI: 10.1136/jnis.2009.001040. View

15.

Luo C, Teng M, Chang F, Chang C . Transarterial balloon-assisted n-butyl-2-cyanoacrylate embolization of direct carotid cavernous fistulas. AJNR Am J Neuroradiol. 2006; 27(7):1535-40. PMC: 7977514. View

16.

Locke C . INTRACRANIAL ARTERIO-VENOUS ANEURISM OR PULSATING EXOPHTHALMOS. Ann Surg. 1924; 80(2):272-85. PMC: 1399709. DOI: 10.1097/00000658-192408000-00012. View

17.

Luo C, Teng M, Chang F, Lin C, Guo W, Chang C . Transarterial detachable coil embolization of direct carotid-cavernous fistula: immediate and long-term outcomes. J Chin Med Assoc. 2013; 76(1):31-6. DOI: 10.1016/j.jcma.2012.09.007. View

18.

Archondakis E, Pero G, Valvassori L, Boccardi E, Scialfa G . Angiographic follow-up of traumatic carotid cavernous fistulas treated with endovascular stent graft placement. AJNR Am J Neuroradiol. 2007; 28(2):342-7. PMC: 7977413. View

19.

Kupersmith M, Stiebel-Kalish H, Huna-Baron R, Setton A, Niimi Y, Langer D . Cavernous carotid aneurysms rarely cause subarachnoid hemorrhage or major neurologic morbidity. J Stroke Cerebrovasc Dis. 2007; 11(1):9-14. DOI: 10.1053/jscd.2002.123969. View

20.

SERBINENKO F . Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg. 1974; 41(2):125-45. DOI: 10.3171/jns.1974.41.2.0125. View