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AJNR - American Journal of Neuroradiology

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Transarterial Balloon-Assisted n-Butyl-2-Cyanoacrylate Embolization of Direct Carotid Cavernous Fistulas

C.-B. Luo^a, M.M.H. Teng^a, F.-C. Chang^a and C.-Y. Chang^a

^a From the Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C

View larger version (62K): [in a new window]   Fig 1. Images of a 49-year man with a traumatic DCCF and a traumatic aneurysm at the left supraclinoid ICA. A, Left lateral carotid angiogram reveals a residual fistula after a detachable balloon embolization. B and C, Two GDCs were placed into the cavernous sinus. Further coil embolization to achieve angiographic cure failed because of recoil of the microcatheter, and the traumatic aneurysm was occluded by GDC (arrowhead). Under a protective balloon (arrows) at the cavernous portion of the ICA, a total of 0.5 mL of n-BCA mixture was infused into the cavernous sinus. D, Postembolization angiogram reveals total obliteration of the residual fistula with preservation of the ICA flow.

View larger version (51K): [in a new window]   Fig 2. Images of a 40-year-old man with traumatic DCCF. A, Right lateral carotid angiogram shows a residual fistula after 2 detached balloons and 1 coil embolization. B, A total of 1.1 mL n-BCA mixture was slowly deposited to the cavernous sinus in 2 attempts. C, Postembolization angiogram shows total occlusion of the fistula with ICA preservation.

View larger version (48K): [in a new window]   Fig 3. Images of a 38-year-old woman with a DCCF; the DCCF was successfully occluded by a detached balloon with patency of the ICA. A, Premature balloon deflation causes recurrent DCCF and drains to the superior ophthalmic vein. Navigation of the additional balloon into the cavernous sinus failed because of blockage by a previously detached balloon (arrow). B and C, One GDC and 0.7 mL of n-BCA mixture were injected into the cavernous sinus under a protective balloon at the cavernous portion of the ICA (arrows), resulting in an angiographic cure of the recurrent DCCF with ICA preservation. Note a small asymptomatic false sac (arrowhead) at the cavernous sinus owing to insufficient NBCA filling.

View larger version (51K): [in a new window]   Fig 4. Images of a 50-year-old man in whom the DCCF failed to occlude because of repeated puncture of the balloons. A, Left lateral angiogram shows a DCCF. B and C, The fistula was successfully obliterated with ICA preservation by a microcoil and 1 mL of n-BCA mixture.