Endovascular Treatment of Traumatic Carotid Cavernous Fistula

Objectives: To evaluate the technical success, complications, and outcome of endovascular management of posttraumatic carotid cavernous fistula (CCF) in patients presenting at Lahore General Hospital (LGH) Lahore, Pakistan. Methods: All patients with CCF treated by transballoon arterial embolization were reviewed from January 2016 to December 2018. A total of 48 patients with CCF were treated in angiography suite of LGH, Lahore. 20 (41.6%) patients had deployment of single balloon Gold ball valve balloon (Balt). 18 (37.5%) were treated successfully with the double-balloon technique. 10 (20.8%) had occlusion of cervical part of internal carotid artery with detachable balloon after confirming contralateral flow due to their very large size of fistula. There were 45 (93.71%) males and 3 females. The median age was 36 years, ranging from 20 to 55 years. All patients had CCF caused by trauma and presented with ocular and orbital symptoms, including orbital bruits, deterioration of visual acuity, chemosis, and pulsatile proptosis. Results: A total of 42 (87.5%) patients showed full recovery with detachable balloons. Three (6.25%) patients presented with recurred symptoms due to displacement of balloon, and in 5 (10.4%) patients fistula showed partial closure but symptoms improved significantly. Conclusion: The detachable balloon technique for transarterial treatment of CCFs is a feasible method that increases the chance of completely occluding the orifice of the CCF. Balloon embolization appears more economical and simple as compared to coil or onyx embolization.

Publication History

Article published online:
26 April 2021