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.

Embolization treatment with detachable balloon for traumatic carotid-cavernous fistulas / 中华创伤杂志

Objective To investigate the main technical points of detachable balloon in management of traumatic carotid-cavernous fistulas (TCCF) and evaluate objectively the clinical outcome.Methods A total of 59 patients with TCCF were treated with detachable balloons,which involved 64 embolization procedures.Follow-up ranged from 3 months to 2 years. Results Forty-eight patients with TCCF (81％) were successfully occluded with patency of internal carotid artery.The rest 11 patients were obstructed in both the fistula and the internal carotid artery.Recurrent TCCF was found within three days after embolization in five patients (with a recurrence rate of 8％ ) who underwent further embolization,of whom one patient went blind after the procedtre and the eyesight showed no recovery even after another embolization with balloon for successful occlusion of the fistula; one patient presented with intracerebral hematoma at day 3 postoperatively and underwent emergency embolization again to occlude the internal carotid artery and fistula,with slight paralysis of the left limb. Conclusions Embolization of TCCF with detachable balloon is a reliable treatment,which is characterized by slight injury and high safety.However,the disease' s development should be strictly observed after the treatment.In the case of recurrence of symptoms,brain angiography and CT scanning should be rechecked timely and emergency treatment should be performed.

Transarterial endovascular treatment of traumatic direct carotid-cavernous fistulas: a report of 51 cases / 介入放射学杂志

Objective To present our single-center experience in treating traumatic direct carotidcavemous fistulas (TDCCFs)by using detachable balloon,coil and Willis covered stent via arterial route.Methods During the last five years,transarterial endovascular treatment by using detachable balloon,coil and Willis covered stent was performed in fifty-one consecutive patients of traumatic direct carotid-cavernous fistulas.with a total of 54 TDCCFs.The detachable balloon was the material of first choice,while Willis covered stents and coils were regarded as the back-up materials.A clinical and angiographic follow-up for 348 months (mean 20.8 months) was conducted to evaluate the arterial patency and the stability of embolization.The clinical data were retrospectively analyzed.Results By using the detachable balloon alone via transarterial route.85%TDCCFs were successfully treated with good preservation of ICA.A total of 98% TDCCFs in this study were successfully treated by using detachable balloon,coil and/or Willis coveted stent,the fistulas became occluded,and ICAs were preserved except one patient.Forty TDCCFs were treated with detachable balloons alone,two TDCCFs with the Willis covered stent alone,and one DCCF with coils alone.Eight TDCCFs were treated with detachable balloons together with Willis covered stent.Of these eight TDCCFs,two were treated with a single session,three were treated with detachable halloons in combination with coils,and one had to receive Willis covered stent.Second and third times of endovascular treatment were needed in 12 TDCCFs.The TDCCF-rel(at)ed symptoms were gradually relived or improved within 1 day to 6 months after treatment,except for five patients who suffered from ipsilateral moderate visual loss or cranial nerve deficit.No perioperative complications.such as vessel rupture,distal embolization or new neurologic deficits,occurred.During the follow-up period lasting for six months,neither delayed neurologic or vascular complications nor recurrence of the lesions developed.Conclusion Via the transarterial route,using detachable balloon to occlude the fistula and at the same time to preserve ICA remains the optimal treatment for TDCCFs.When the standard treatment fails.various coils and the Willis covered stents can be used as an effective alternative or remedial tool in the treatment of TDCCFs,which can preserve ICA.Willis covered stent deployment seems to be an effective,safe,feasible and economical endovasculal treatment for TDCCF,but more clinical studies are needed before we can further clarify its specifications and indications.

Implantable Microballoons: An Alternative in the Treatment of Stress Urinary Incontinence Associated with Intrinsic Sphincter Deficiency / 대한비뇨기과학회지

PURPOSE: All current bulking agents employed for treating intrinsic sphincter deficiency (ISD) have some limitations due to various side effects, technical difficulties and inadequate long-term results. Self-detachable balloon system (SDBS) was tested as a new therapeutic modality for female urinary incontinence. MATERIALS AND METHODS: SDBS which consists of the self-detachable cross-linked silicone balloon, biocompatible filler material and a delivery system was implanted. Fourteen famale patients with ISD were included in the prospective trials. Two to five balloons were implanted per patient. Patients were followed up with incontinence questionnaire, pad tests and determination of Valsalva leak point pressure (VLPP) at 1, 3, 6, 12 and 18 months. RESULTS: The biocompatibility of the microballoons was excellent. With a mean follow-up of 10.1 months, 28.9% (4/14) of the patients were completely dry. 21.1% (3/14) of the patients showed socially dry and 3 patients (21.1%) showed improvement. 28.9% (4/14) of patients were deteriorated during follow-up. Three patients had spontaneous delivery of SDBS. The pad test improved from a preoperative mean of 102.1g to a postoperative mean of 22.4g. The VLPP increased from a preoperative mean of 49.7cmH2O to a postoperative mean 89.8cmH2O. CONCLUSIONS: The implantation of microballoons is a safe, well-tolerated, minimally invasive and clinically effective modality for the treatment of ISD.

Transcatheter arterial embolization with detachable balloon for pulmonary arteriovenous fistula / 第二军医大学学报

Objective:To evaluate the efficacy of transcatheter arterial embolization with detachable balloon for pulmonary arteriovenous fistula(PAVF). Methods: A 48 year old female with PAVF suffered intermittent emoptysis, fatigability, exertional dyspnea, and palpitations. CT and MRI demonstrated 2 PAVF in the module lobe on right side. Pre embolization super selective pulmonary angiography revealed 2 fistulae communicating to the sac of the lesion.Three detachable balloons were used for embolization of the feeding arterial branch.The diameter of detachable balloons was twice as that of the feeding arterial branch. The study of blood gases showed the arterial oxygen pressure was 6.5 kPa before operation, hemoglobin at 158 g/L. Results: No complications were apparent in our case. Two PAVF were completely occuluded by the embolization of a feeding branch. One month later, the arterial oxygen pressure increased to normal values, hemoglobin at 125 g/L and clinical symptoms disappeared. On postcontrast CT, the fistulas treated by the embolization of a feeding arterial branch were not enhanced. No symptoms and signs were found in follow up for 16 months. Conclusion: The percutaneous transcatheter embolization with detachable balloon is effective for PAVF. [

A Case of Internal Carotid Artery Traumatic Pseudoaneurysm with Epistaxis: Treated with Detachable Balloon Occlusion (DBO) and Detachable Coil / 대한이비인후과학회지

Traumatic pseudoaneurysm of the intracavernous internal carotid artery (ICA) is rare, but it is life threatening because of massive epistaxis. Unfortunately, the prompt diagnosis and treatment of this desease are frequently delayed due to its rarity and latent period. Optimal therapy for this diseases is essential in order to minimize its morbidity and mortality. The authors present a case of male patient with traumatic pseudoaneurysm of ICA. This patient was a 24-year-old male with a multiple facial bone fracture, with unilateral blindness and recurrent massive epistaxis after suffering a head trauma. Computed tomography, MRI and carotid artery angiogram showed intracavernous pseudoaneurysm. The patient was effectively treated with occlusion of the ICA circulation by endovascular treatment utilizing detachable balloon occlusion (DBO) and mechanically detachable tungsten coils.

Central Retinal Vein Occlusion During Embolization for Carotid Cavernous Sinus Fistula

Most trauma induced fistulas are direct communications between the intracavernous carotid artery and the cavernous sinus. Theses abnormal communications are characterized by high pressure, high blood flow and a clinically obvious constellation of symptoms and signs. We here in report a patient with traumatic carotid cavernous sinus fistula(CCSF). who developed central retinal vein occlusion(CRVO) during detachable balloon embolization. The mechanism of CRVO occurring during detachable balloon embolization. The mechanism of CRVO occurring during detachable ballon embolization for CCSF was discussed. We report this case with the review of previous reports.

Clinical and Radiological Analysis of Carotid Cavernous Fistula and Detachable Balloon Occlusion: Case Report

Carotid-cavernous fistula is a serious complication of head trauma. We have experienced 5 cases of carotid-cavernous fistula(four cases were traumatic and one was spontaneous) recently and have successfully managed them by detachable balloon occlusion. We have found that while some cases had typical manifestations, the others had atypical features. We therefore concluded that clinical suspicion and early imaging studies are essential steps in the management of carotid-cavernous fistula. Careful monitoring and prompt treatment are important because of its dismal progression and poor outcome. Detachable balloon occlusion is a method of choice in management of carotid-cavernous fistula, because it can be used under local anesthesia. It provides a chance of early detection of neurological deterioration during the procedure and it can be, if necessary performed during diagnostic procedures.

GDC(Guglielmi Detachable Coil) Embolization Used in Carotid-Cavernous Fistula Incompletely Occluded by Detachable Balloon

For the treatment of carotid-cavernous fistula, detachable balloon occlusion(DBO) is the method of choice. When it fails, or when the fistula is incompletely occluded, alternative treatment methods include direct surgery and internal carotid artery occlusion at the proximal and distal portion of the fistula. Before ligation or occlusion of the internal carotid artery, however, coil embolization should be considered, as this preserves patent internal carotid artery. The authors used DBO in a 22-year-old male patient with carotid-cavernous fistula which developed after head injury. During the procedures the fistula was partially obstructed by one detachable balloon. In spite of several attempted occlusions with a second balloon, this could not be introduced into the small remnant fistula hole. The second stage of intervention involved embolization with a Guglielmi detachable coil(GDC) ; this was successfully introduced into the partially obstructed fistula, which was thus completely occluded, and the patient's clinical symptoms improved. In this case, GDC emboization was an effective tool for the treatment of carotid-cavernous fistula incompletely occluded by a detachable balloon.

GDC(Guglielmi Detachable Coil) Embolization Used in Carotid-Cavernous Fistula Incompletely Occluded by Detachable Balloon

For the treatment of carotid-cavernous fistula, detachable balloon occlusion(DBO) is the method of choice. When it fails, or when the fistula is incompletely occluded, alternative treatment methods include direct surgery and internal carotid artery occlusion at the proximal and distal portion of the fistula. Before ligation or occlusion of the internal carotid artery, however, coil embolization should be considered, as this preserves patent internal carotid artery. The authors used DBO in a 22-year-old male patient with carotid-cavernous fistula which developed after head injury. During the procedures the fistula was partially obstructed by one detachable balloon. In spite of several attempted occlusions with a second balloon, this could not be introduced into the small remnant fistula hole. The second stage of intervention involved embolization with a Guglielmi detachable coil(GDC) ; this was successfully introduced into the partially obstructed fistula, which was thus completely occluded, and the patient's clinical symptoms improved. In this case, GDC emboization was an effective tool for the treatment of carotid-cavernous fistula incompletely occluded by a detachable balloon.

Clinical Analysis of Traumatic carotid Cavernous Fistula

We analyzed 20 cases of traumatic carotid cavernous fistula(CCF) during the recent 10 years The results are summarized as follows: 1) In 18 cases(90%), the clinical symptoms & signs of CCF occurred within 2 months after trauma. 2) The sites of fistulae were common in horizontal segment(40%) and at the junction(30%) between horizontal segment and posterior ascending segment of cavernous portion of internal carotid artery. 3) The main draining veins of CCF were the superior ophthalmic vein(90%) and the inferior petrosal sinus(70%). 4) The methods of treatment were occlusion of fistula with balloon(9 cases), occlusion of cavernous ICA with balloon(2 cases), ligation of cervical ICA with Poppen's clamp(4 cases) and trapping(2 cases). Two patients were not treated and another patient was healed spontaneously. 5) The frequency and severity of complication was significantly decreased in cases treated by detachable balloon occlusion than by direct cervical ICA ligation or trapping procedures. 6) The procedure using the self-sealed goldvalve balloon was simple, but had a risk of premature separation and premature deflation.

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.

Traumatic Intracranial Aneurysms

Five cases of traumatic intracranial aneurysm were presented. All of them were located at the cavernous segment of the internal carotid artery. These lesions were associated with basal skull fracture. Four cases were presented with massive epistaxis, and two of them required transfusion. All cases were treated successfully:four by detachable balloon occlusion of the proximal internal carotid artery and one by trapping of the lesion at the internal carotid artery. Because the mortality rate of ruptured traumatic aneurysm if high, clinical suspicion must be focused on prompt diagnostic work-up and early treatment.

Carotid-Cavernous Fistula

Carotid-cavernous fistula(CCF) is the most common arteria-venous fistula in the head and neck region which has characteristic ophthalmic findings and threat of visual loss. An analysis of clinical records was done of 21 CCF patients who visited the Department of Ophthalmology, Seoul National University Hospital from August 1, 1986 to July 31, 1990. Seventeen cases(81.0%) were of the direct type, and four cases(19.0%) were of the indirect or spontaneous type. Fifteen patients(88.2%) of the direct type had a definite history of recent head trauma. Clinical symptoms on the first visit included exophthalmos(76.2%), conjunctival injection(76.2%), noise in cranial cavity(76.2%), visual disturbance(61.9%), diplopia(42.9%), and ocular pain(28.6%). In general ocular examination, exophthalmometry revealed proptosis in all cases. In seventeen cases(81.0%) vascular bruit was heard with auscultation on the eyelid. Eleven cases(52.4%) showed a limitation of ocular movement and sixth nerve palsy was the most common type(45.5%). On funduscopic examination, nine patients(42.9%) showed engorged retinal vessels. Increased intraocular pressure(Ta>21 mmHg) was recorded in 9 patients(42.9%). Computerized tomography(CT) of orbit or brain, and percutaneous transarterial carotid angiography were used as a diagnostic procedure in all patients. In thirteen of 17 direct type patients detachable balloon embolization was done at the time of angiography, and in 12 cases(92.3%) fistulas were successfully embolized.

A Successful Occlusion of Traumatic Carotico-Cavernous Fistula with Debrun's Detachable Balloon Catheter

A case of traumatic carotico-cavernous fistula was managed by intravascular occlusion using detachable balloon catheter. The great advantage of this technique is that the cerebral blood flow can usually be preserved after the occlusion of the fistula. The fistula was obliterated by this procedure. The radiological feature, symptomatology and management were discussed with brief review of the literature.

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.

Management of Aneurysm of the Petrous Portion of the Internal Carotid Artery by Balloon Technique: A Case Report

Authors report a case of intrapetrosal carotid aneurysm which was successfully treated with Debrun's detachable balloon technique. The patients was a 21 year-old female with headache, vertigo and left facial palsy in whom aneurysm arising from the intrapetrosal segment of internal carotid artery was demonstrated.

Treatment of Carotid-Cavernous Fistula and Internal Carotid Aneurysm with Debrun's Latex Detachable Balloon Catheter Technique

The two cases, one carotid-cavernous fistula and one giant aneurysm of internal carotid artery, treated with Debrun's latex detachable balloon catheter technique are reported. Case 1 was a 50-year-old man who had proptosis, chemosis and 3rd nerve palsy in his right eye. His cerebral angiography showed typical traumatic carotid-cavernous fistula. Following complete radiologic and neurologic examination, the fistulous opening was successfully occluded with preservation of the internal carotid artery using latex detachable balloon. Immediately after occlusion of the fistula the clinical symptoms were markedly improved. Only transient facial pain occurred as a complication. Case 2 was a 21-year-old woman who had a dizziness and left facial nerve palsy. The cerebral angiography showed a giant aneurysm at the petrous portion of left internal carotid artery. The patient tolerated occlusion of the left carotid artery. The left internal carotid artery was completely occluded with 3 detachable balloons. The patient had no complications during 9 days follow-up. The procedures and complications of detachable balloon catheter technique will be described and discussed.