Endovascular embolization with detachable balloon for traumatic carotid-cavernous fistulae：clinical experience in 188 cases / 介入放射学杂志

Objective To evaluate the clinical efficacy of endovascular embolization with detachable balloon, based on the characteristics of traumatic carotid-cavernous fistulae (TCCF), in treating TCCF. Methods The clinical data of 188 patients with TCCF, who had received endovascular embolization with detachable balloon via femoral artery access, were retrospectively analyzed. The risk factors for recurrence were statistically analyzed. Results Of the total 188 patients, complete cure after the first balloon embolization was obtained in 160, certain improvement of clinical symptoms was achieved in 22, and balloon embolization failed in 6, for whom other surgical options had to be carried out. Complications occurred in three patients. Recurrence was seen in 23 patients within the period from one day to 5 years after the treatment, and the recurrent lesion was successfully cured in all patients. Univariate analysis and chi square test or correction chi square test indicated that factors affecting postoperative recurrence were the use of multiple balloons for embolization and the presence of residual fistula after operation (P0.05). Multivariate logistic regression analysis revealed that the independent factors affecting recurrence included the number of used balloon≥2 (OR=7.80, 95%CI:2.28-26.73,P=0.001) and postoperative residual fistula that was observed immediately after the embolization (OR=10.46, 95%CI:2.99-36.50,P=0.000). Conclusion For the treatment of TCCF, transcatheter embolization with detachable balloon is minimally-invasive, safe and reliable with fewer complications, therefore, this technique should be regarded as the therapy of first choice. The use of multiple balloons and the presence of residual fistula observed immediately after the embolization procedure are the risk factors for recurrence. Other possible risk factors are still to be furtherstudied.

Follow-Up of 58 Traumatic Carotid-Cavernous Fistulas after Endovascular Detachable-Balloon Embolization at a Single Center

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.

Perioperative nursing of traumatic carotid-cavernous fistula by intervention / 中国实用护理杂志

Objective To investigate the nursing of traumatic carotid-cavernous fistula(TCCF)by intervention.Methods 18 patients with TCCF by intervention were given nursing measures including psychological preparation,eye care,disease observation and complications care.Results All patients gained successful embolization,and the symptoms of proptosis and vascular murmur in patients were alleviated.One case received spring embolism because of balloon rupture.The symptoms of vascular spasm in two patients were alleviated with timely treatment.Hyperperfusion syndrome was relieved after lowering blood pressure in two patients.Conclusions The intervention embolization is an effective treatment of TCCF.Good nursing could improve the efficacy and reduce the incidence of complications.

The occurrence of traumatic cavotid carernous fistla after fracture of basilaris cranii and its associated factors with outcome / 中华急诊医学杂志

Objective To analyze the occurrence of traumatic carotid cavemons fistula (TCCF) resulted from the fracture of basilaris cranii, in order to find out the related factors to outcomes and to discuss the approaches to improving prognosis.Method Data of 312 patients with the fracture of skull base complicatcd with TCCF con-firmed angiography from 1999 to 2005 were analyzed. These patients were classified into patients with disable and patients without disabed. The factors potentially impacting on outcomes were analyzed. Results The overall inci-dence of TCCF in 312 patients with fracture of basilaris cranii was 3.8% .The incideucs of TCCF occurred in pa-tients with the fracture of anterior fossa, middle fossa and posterior fossa accounted for 2.4%, 8.3 % and 1.7 %, respectively. Between two cohorts of patients, there were no difference in age, gender, number of embelization proce-dares performed and the time from injury to appearence of the first symptom except the differencc in time from ap-pearence of the first symptom to the intravascular embohzation performed (P>0.05). Conclusions A relatively high incidence of TCCF occurs in patients with middle fossa fractures, especially those with transverse or oblique fractures. Prompt diagnosis and intervention can not be emphasized in case of patients with TCCF, and non inva-sive techniques for the early detection of TCCF under certain circumstance after brain or facial trauma should be considered so as to avoid a miss in the early diagnosis of middle fossa fracture to ensure favourable outcomes.

Nonspecific Traumatic Carotid-Cavernous Fistula Presented as Naso-Orbital Mass

Traumatic carotid-cavernous fistulae(TCCF) are rare but can cause potentially lethal complications such as visual loss and subarachnoid hemorrhage after craniomaxillofacial trauma. This represents aberrant vascular communication in skull base between the carotid artery system and the venous channels within the cavernous sinuses of a sphenoid bone. The symptoms are mostly related with ophthalmic problems such as pulsatile proptosis, chemosis, and diplopia. The standard diagnostic method is cerebral angiography. CT and MRI can be also useful. The main current treatment is endovascular detachable balloon occlusion. The clinicians who treat patients with craniofacial injuries should have complete understandings of this pathological entity, so that early diagnosis and urgent intervention can be done to avoid serious complications and to get successful results. We report the experience of treating a 25-year-old female with nonspecific traumatic carotid-cavernous fistula presented as naso-orbital mass using intravascular detachable balloon catheter embolization.

Clinical Analysis of Traumatic Carotid-Cavernous Fistula

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.

Clinical Analysis of Traumatic Carotid-Cavernous Fistula

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.

Regional Cerebral Blood Flow Changes in Traumatic Carotid Cavernous Fistula During Trapping Procedure: Case Study, Preliminary Report

Carotid cavernous sinus fistula is abnormal communication between the carotid artery and the cavernous sinus. It can be classified according to three criteria : 1) pathologically into spontaneous or traumatic ; 2) hemodynamically into high flow or low flow fistula ; 3) angiographically into direct or dural fistula. We studied the regional cerebral blood flow changes in traumatic carotid cavernous sinus fistula. Regional cerebral blood flow checked 7 times during trapping procedure. The results are as follows ; 1) regional cerebral blood flow decreased in normal side than in lesion side hemisphere in the state of carotid cavernous fistula. 2) After compression of lesion side common carotid artery over 10 minutes, cerebral blood flow increased in both side. 3) Cerebral blood flow decreased temporary after operation on both side but normalized 2 or 3 weeks later.

Treatment of Traumatic Carotid-cavernous Fistula Using Debrun's Latex Detachable Balloon

A case of traumatic carotid-cavernous fistula treated by using Debrun's latex detachable balloon catheter is reported. The patient was a 28 year old man, who had complaints of headache, proptosis and chemosis of left eye 3 weeks after motor vehicle accident. The cerebral angiography showed direct fistula between intracavernous portion of internal carotid artery and cavernous sinus as high flow type. Following complete radiologic and neurologic examination, the fistulous opening was successfully occluded by Debrun's latex detachable balloon. Immediately after occlusion of the fistula the clinical symptoms were markedly improved.

Treatment of Traumatic Carotid-cavernous Fistular using Debrun's Latex Detatchable Balloon

A case of traumatic carotid-cavernous fistula treated using Debrun's latex detatchable balloon catheter is reported. The patient was a 33-year-old man, who has complaints of proptosis and chemosis of left eye 2 months after motor vehicle accident. The cerebral angiography showed direct fistula between intracavernous portion of internal carotid artery and cavernous sinus as high flow-high pressure type. After complete radiologic and neurologic examination, the fistulous opening was successfully occluded by Debrun's latex detatchable balloon with transient ischemic attack, was resolved 2 hours after the procedure.