Detachable Balloon Embolization: Concomitant Use of a Second Safety Balloon
Thomas J. Masaryk
,a,
John Perl IIa,
Robert C. Wallacea,
Michelle Magdineca and
Douglas Chyattea
a From the Departments of Neuroradiology (T.J.M., J.P., M.M.) and Neurological Surgery (T.J.M., D.C.), The Cleveland Clinic Foundation; and the Department of Neuroradiology/Angiography, Barrow Neurological Institute, Phoenix (R.C.W.).
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FIG 1. A and B, Lateral (A) and anteroposterior (B) catheter angiograms show a direct CCF with rapid filling of the cavernous sinus, superior ophthalmic vein, and inferior petrosal sinus.
C, Anteroposterior view of the left vertebral artery injection similarly shows filling of the right cavernous sinus via a persistent trigeminal artery (arrowhead).
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FIG 2. A and B, Lateral (A) and anteroposterior (B) views of the right internal carotid artery injected after initial placement of a detachable silicone balloon through the rent in the internal carotid artery. This placement is facilitated by the use of a second, nondetachable balloon.
C, Lateral view of the left vertebral artery injection shows the balloon catheter in place (arrowhead denotes the platinum tip of the catheter) with absence of filling of the persistent trigeminal artery.
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FIG 3. A, Detachable silicone balloon securely placed (open arrow) just prior to inflation of a nondetachable balloon (arrowheads) precludes migration of detachable balloon into the carotid.
B, Diagrammatic representation of placement of the detachable balloon within the cavernous sinus, followed by inflation and sealing of the fistula with positioning of the nondetachable balloon at the defect in the vessel. Finally, the balloon is detached only after inflation of the nondetachable balloon within the carotid, effectively precluding migration and
errant embolization of the detachable balloon into the internal carotid artery.
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