ENDOVASCULAR TREATMENT OF CAROTID-CAVERNOUS FISTULAS WITH LONG-TERM FOL- LOW-UP: FROM BALLOON DEPLOYMENT TO STENT-GRAFT PARENT ARTERY RECONSTRUCTION

BU-LANG GAO, XUE-JING ZHANG, WEI-LI HAO, QIONG-YING FAN, CONG-HUI LI, SONG-TAO YANG

Departments of Medical Research (Bu-Lang Gao, Xue-Jing Zhang, Wei-Li Hao, Qiong-Ying Fan), and Neurosurgery (Bu-Lang Gao, Cong-Hui Li, Song-Tao Yang), Shijiazhuang First Hospital, Hebei Medical University

Introduction: The long-term effect of endovascular treatment for traumatic direct carotid-cavernous fistulas (CCF) and this study served this purpose with the focus on the initial balloon deployment to stent-graft parent artery reconstruction.

Materials and methods: Between 1999 and 2012, 32 patients with traumatic direct CCFs were treated endovascularly at our institution and retrospectively analyzed. All patients had cerebral angiography for the diagnosis of CCF. Treatment modalities inclu- ded balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery (ICA) with detachable balloons, coil emboliza- tion of the CCF and secondary pseudoaneurysms, and covered-stent reconstruction of the parent artery.

Results: All patients were successfully managed endovascularly. Three patients were initially treated with ICA sacrifice, 19 with detachable balloons or coils, and the remaining 10 with a covered stent. At angiographic follow-up (2-24 months), four (21.1%) of the 19 patients treated with detachable balloons and coils developed a pseudoaneurysm after occlusion of the CCF, and four (21.1%) patients recurred and were retreated with ICA sacrifice in three and coil embolization in one. In total, 29 embolization pro- cedures were performed for the 19 patients with detachable balloons or coils, and six (27.3%) patients experienced permanent ICA occlusion before the application of the covered stent. Of 10 patients with covered stents, four patients initially failed detachable bal- loon deployment. Clinical follow-up (12-72 months) revealed complete occlusion of all the CCFs with no recurrence of CCF symp- toms and signs.

Conclusion: Traumatic direct CCFs can be successfully managed endovascularly with increasingly better effects from deta- chable balloons to covered stent reconstruction of ICA