Percutaneous Transarterial Embolotherapy of Carotid-Cavernous Fistula

ABSTRACT

It is known that the percutaneous transarterial embolotherapy is the procedure of choice for the treatment of the carotid-cavernous fistula (CCF) ; The detachable balloons are utilized for the treatment of direct CCF, and particles or fluid materials for the indirect CCF (a kind of dural AV malformation) as embolic agents. We have experienced 14 cases of CCF over last 3 1/2 years. We present the results of our clinical experience including complications and technical problems. Eleven of 12 patients with direct CCF have been successfully treated with Debrun's latex detachable balloons, and 2 indirect CCF with PVA, Gelfoam particles or IBCA. In 6 (50%) of 12 direct CCF the only fistula was occluded with the preservation of internal carotid artery was originally occluded with the fistula. One patient underwent surgical ligation due to complication of embolotherapy. In two patients with indirect CCF the involved dural branches of external carotid artery were almost completely embolized ; One of both revealed recurrence 1 week after the procedure, producing symptoms and signs of original state. We encountered two cases of unexpected major complications during the procedures.