Efficacy evaluation of embolization with Scepter balloon-assisted coils and Onyx glue for traumatic carotid cavernous fistula / 中华创伤杂志

ABSTRACT

Objective To evaluate the efficacy and safety of embolization with Scepter balloonassisted coils and Onyx glue in treatment of traumatic carotid cavernous fistula (TCCF).Methods A retrospective case series study was conducted on the clinical data of 24 patients with TCCF managed with embolization with Scepter balloon-assisted coils and Onyx glue from February 2012 to February 2017.There were 20 males and 4 females,aged 21-65 years [(42.6 ± 6.8) years],with Glasgow coma scale (GCS) of 15 points.All patients were with unilateral lesions,with 13 on the right and 11 on the left.Among TCCF patients,23 patients were with cranial bruit,22 with pulsating exophthalmos and bulbar conjunctiva congestion edema,19 with orbital symptoms,and 9 with visual impairment.A micro-catheter was sent into the cavernous sinus of lesion side,and the location of traumatic carotid cavernous fistula and draining characteristics were identified by micro catheter contrast.With a balloon inflated to cover the fistula and protect the interual carotid artery,Onyx was injected into the cavernous sinus after several coils were deployed adjacent to the fistula until the complete occlusion of fistula.Cranial bruit,pulsating exophthalmos,visual impairment,and orbital symptoms before operation and 2 weeks after operation were observed.Six months after operation,digital subtraction angiography (DSA) was reviewed to evaluate the carotid artery patency and TCCF recurrence.Results The cranial bruit,pulsating exophthalmos,and bulbar conjunctiva congestion edema in all TCCF patients disappeared 2 weeks after operation.No obvious improvement was seen in 2 out of 9 patients with visual impairments and 2 out of 19 patients with orbital symptoms,but there was significant improvement after operation (P ＜ 0.05).Onyx glue adhering to the surface of the protective balloon occurred in one patient.The balloon and catheter were delivered to the external carotid artery and then removed,with no complication seen.Follow-up found no recurrence or operative complications in 6-12 months.Complete occlusion of fistula was seen in all patients,and the internal carotid artery showed good patency.Conclusion Embolization with Scepter balloon-assisted coils and Onyx glue can occlude fistula,eliminate ocular symptoms,and maintain internal carotid artery patency and hence is an effective and safe treatment option for TCCF.