Detachable Balloon Embolization: Safety Balloon Technique

Masarayk et al have given an excellent description of a technique used during deployment of a detachable balloon in a carotid cavernous fistula (1). Their technique involves placement of two introducer catheters in the carotid artery and placement of parallel microcatheters, one carrying a detachable balloon, the other a nondetachable balloon. The nondetachable balloon can then be used either to extrude the detachable balloon through the fistula to the venous side or stabilize it there during detachment. I have used a similar technique in the treatment of several carotid cavernous fistulas and found it to be extremely useful in preventing backward traction on the detachable balloon. Moreover, the technique is also very helpful in balloon occlusion of carotid arteries, where it significantly reduces the tendency of detachable silicone balloons (DSB) to slip back down the artery during traction on the microcatheter. A convenient improvement in technique that readers might find useful is that the entire procedure can be performed with a single 7F or 8F introducer catheter using a single-port Y-adaptor. This can be performed by advancing the DSB first through the main catheter. Be sure that it is all the way out of the catheter, lest the following nondetachable balloon should catch it within the catheter and cause it to detach inadvertently and embolize. A non-detachable Endeavor balloon (Boston Scientific, Watertown, MA) can be stiffened with a Transend 0.010-cm wire (Boston Scientific) and then advanced in a parallel direction through the first catheter. It can be inflated with the wire in place by using a Tuohy-Borst adaptor. The nondetachable balloon then can be used to stabilize the DSB during detachment either within a fistula or within an artery. In several consecutive cases, I have had no difficulty detaching the more distal DSB, even though the mounting microcatheter is pinioned against the vessel wall by the inflated Endeavor balloon. In my experience, this technique has greatly facilitated ease and accuracy of detachment positions in use of DSBs and is now employed routinely in all DSB cases.