Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions

Abstract

Of the cerebral vascular lesions that can be treated with intravascular detachable balloon techniques, carotid-cavernous sinus fistulas and vertebro-vertebral fistulas have the best results. The great advantage of this technique is that the cerebral blood flow can usually be preserved after the occlusion of the fistula. The authors report 17 postraumatic carotid-cavernous sinus fistulas successfully treated with preservation of the carotid blood flow in 12 cases. None of the patients died, and the morbidity was limited to one case of third nerve palsy. The treatment of aneurysms by this method is, however, much more difficult and dangerous. Of 14 cases treated, seven good results were obtained. Two patients died and two had a poor outcome. The embolization of certain brain angiomas with calibrated-leak balloons using bucrylate promises to be important in the future.

Tratamento endovascular de fístula arteriovenosa vertebral espontânea em criança: relato de caso

“…O esvaziamento de balões destacáveis acontece progressivamente entre três a quatro semanas após a embolização, permitindo neste intervalo a trombose e a resolução adequada da fístula 16 .…”

Endovascular Graft-Stent Placement for Treatment of Traumatic Carotid Cavernous Fistulas

“…Ischemic complications after occlusion of the ICA occur in 5% to 22% of patients, despite a tolerant balloon occlusion test 3) . Despite the enormous progress made in endovascular techniques over the past few decades, detachable balloons remain the method of choice for the treatment of CCF with reported success rates of 75-88% in terms of preserving the patency of the parent ICA 4,12,13) . Although they are excellent therapeutic devices, there are some situations when detachable balloons cannot be used, if preservation of the parent artery is desired, particularly when the following are present : 1) a small orifice that does not allow the balloon passage, 2) a small cavernous sinus that causes the balloon to be herniated into the parent ICA, 3) sharp osseous fragments within the sinus that can cause rupture balloon on inflation, 4) a markedly enlarged cavernous sinus that cannot be completely filled by even multiple balloons, which leaves empty spaces that prevent complete occlusion and cure, and 5) transection of the cavernous ICA.…”

Traumatic Middle Meningeal Artery and Fistula Formation with the Cavernous Sinus and a Review of the Literature on Endovascular Management of Traumatic Carotid Cavernous Fistulas

“…Ever since the use of balloons for the treatment of TCCFs was described by Debrun et al [13] and Serbinenko, [14] transarterial balloon embolization has been the criterion standard treatment for most patients with TCCF. Higashida et al [15] reported preservation of the parent artery in 88% of patients with TCCFs treated by using detachable balloons; other authors have described a need for parent artery occlusion in as many as 20% of cases [16,17].…”