Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons

Abstract

Transarterial embolization of direct carotid-cavernous fistulas (CCFs) using detachable balloons is the best initial option for occlusion of the fistula and preservation of the internal carotid artery. However, the long-term safety and efficacy of this treatment is unknown. The authors reviewed the long-term outcome of 87 patients with 88 direct CCFs occluded by detachable balloons. Clinical follow up was obtained in 48 (83%) of 58 patients treated with latex balloons (mean follow-up period 10 years, range 5.9-15.5 years) and 28 (97%) of 29 patients treated with silicone balloons (mean follow-up period 4 years, range 1-6.6 years). Two patients were treated with both balloon types. There were no late recurrent symptoms of cranial bruit, proptosis, chemosis, or arterialized conjunctiva in patients treated with either latex or silicone balloons. Diplopia improved in all patients; however, five patients required shortening of the lateral rectus muscle. Delayed ischemia occurred in three patients: one patient had a transient ischemic episode 5 years after treatment with latex balloons and two patients (85 and 90 years old) who had ruptured spontaneous intracavernous aneurysms suffered cerebral infarctions 6 weeks and 4 months, respectively, after treatment with silicone balloons. There were five deaths in the series unrelated to balloon treatment. These results show that after transarterial embolization of direct CCFs using either silicone or latex detachable balloons, the long-term risks are low for fistula recurrence, symptomatic foreign body reaction, symptomatic pseudoaneurysm formation, and cerebral ischemia.

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

“…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].…”

Usefulness of Intravascular Ultrasonography Monitoring of Coil Embolization for Traumatic Direct Carotid-Cavernous Fistula -Case Report-

“…Detachable balloons quickly became the method of choice to treat CCF following introduction in the 1970s, [1][2][3]12,19) with preserved patency of the parent ICA in 75-88% of cases. 2,4,6,[10][11][12][13]16) However, detachable balloons cannot be used if preservation of the parent artery is essential, leading to a search for other ways to treat CCF, such as detachable coils and cyanoacrylates. 4,8,11) Direct CCFs have been successfully occluded with coil embolization via either the transarterial or transvenous approach.…”

“…2,4,6,[10][11][12][13]16) However, detachable balloons cannot be used if preservation of the parent artery is essential, leading to a search for other ways to treat CCF, such as detachable coils and cyanoacrylates. 4,8,11) Direct CCFs have been successfully occluded with coil embolization via either the transarterial or transvenous approach. 8,9,14,15,21) Guglielmi detachable coil (GDC) is effective for direct CCFs with small fistulas and/or small cavernous sinuses, because a limited number of GDCs will be required to achieve angiographic cure.…”

Embolización de fístula carótido cavernosa indirecta a través de la vena oftálmica superior

“…La mayoría de las FCC directas pueden cerrarse mediante tratamiento endovascular, generalmente por vía arterial mediante coils o balones 8,17 , aunque también se han obtenido buenos resultados por vía venosa 13 . El tratamiento de las FCC indirectas o durales es más complicado, siendo la vía venosa de elección para la mayoría de los autores 1,7,12,18,21,26 .…”