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Objective There is a direct fistulous connection between the cavernous segment of the internal carotid artery and cavernous sinus in cases of direct carotid-cavernous fistula (CCF). Endovascular embolization is the mainstay of management in this condition. This study is about the evolution of endovascular treatment methods and the development of a cost-effective technique for embolization of direct CCF at a tertiary care center. Materials and Methods A retrospective analysis was performed of all the cases of direct type CCF embolized by endovascular techniques in our department from 2008 to 2018.Clinical follow-up of these patients was done at 1 week, 3 months, and 6 months. Results A total of 45 patients with 40 having a prior history of head trauma were included in this study. All cases were treated with a transarterial route except one which was treated with the transvenous approach. Detachable balloon s were used in 12 (26.67%) patients, only detachable coils in 14 cases (31.11%), both detachable balloons and coils in 9 cases (20%), and both detachable and push coils, that is, sandwich technique in 8 cases (17.78%). Parent arterial occlusion was performed in 10 patients (22.22%). There was complete resolution of chemosis and bruit in all the patients. Conclusion Endovascular treatment is the mainstay of management in direct CCF. Using more fibered thrombogenic coils in a sandwich manner decreases the cost of the treatment significantly.

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PURPOSE: To investigate the effects of detachable balloons in embolizing traumatic carotid cavernous fistulas (TCCFs) and the risk factors for recurrence after balloon embolization. MATERIALS AND METHODS: 188 patients with TCCFs were enrolled, and clinical, treatment, and follow-up data were analyzed for possible risk factors for recurrence after embolization. RESULTS: Among 188 patients, 182 (96.8%) had successful balloon embolization; 6 patients failed. One balloon was used in 94 cases and multiple (two or more) balloons were used in 62 patients. 26 patients had occlusion of the parent artery whereas the remainder had parent artery preservation. Periprocedural complications occurred in 3 patients (1.6%) including cerebral embolism in 1 and abducent nerve paralysis in the other 2. Immediately following embolization, headache appeared in 92 patients and was relieved after 3-5 days with medications. A total of 165 patients (87.8%) had follow-up (6 months to 16 years, mean 5 years). 23 (13.9%) patients with internal carotid artery preservation had recurrence 1-33 days (mean 11 days) after the first embolization and were retreated to complete occlusion. Factors affecting recurrence were multiple balloons and residual fistula (p<0.05). Logistic regression confirmed the independent factors affecting recurrence were multiple balloons (≥2 balloons, OR 7.80, 95% CI 2.28 to 26.73; p=0.001) and residual fistula immediately following embolization (OR 10.46, 95% CI 2.99 to 36.5; p=0.000). CONCLUSION: The recurrence rate is high in the first month after embolization with detachable balloons, and multiple balloons and residual fistula are two independent factors affecting recurrence following balloon embolization.

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BACKGROUND AND PURPOSE: This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. METHODS: Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. RESULTS: All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. CONCLUSIONS: Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence.

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BACKGROUND AND PURPOSE: This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. METHODS: Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. RESULTS: All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. CONCLUSIONS: Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence.

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