Endovascular Embolization By The Femoral Artery-ICA Route For Traumatic Carotid-cavernous Fistula

Objective To investigate and conclude the clinical representation, imaging findings and the therapeutic methods of endovascular embolization for the treatment of TCCF.Method A restrospective analysis of 24 patients with TCCF was conducted from Match 2000 to Match 2006. 24 cases of TCCF, male 20 cases, female 4 cases, age from 27 to 50 years old. All patients with TCCF confirmed by cerebral angiography with Seldinger technique adopted in puncture of femoral artery under heparinization and neuro-sonacon anaesthesia. When the sites, character, size of the fistula, and cerebral circulation condition were confirmed and diagnosed, Magic -BD catheters combining ballon were used to embolize the fistula or the internal carotid artery with co-axial detachable ballon catheter(Balt company,France). Detachable coils were used necessary. The femoral artery route was adopted in all these cases. For the embolization materials, balloons was used in 23 case ,in which ICA were occluded in 3 cases, detachable coil in 1 case.Results 24 cases of TCCF, the left TCCF in 12 cases, the left in 12 cases.Type A in all of 24 cases. The fistulas were located at the junctions of C4 in 18 cases, C3 in 4 and C5 in 2. 26 procedures for embolizations were done. Successful embolization for TCCF in a single procedure was achieved in 21 cases. 2 cases failed due to balloon leakage, and the 2 cases were embolized successful in second attempt.The formation of False aneurysm in 1 cases, then covered stnet was used to cure successfully. The total success rate was 100% in these cases , with a rate of ICA patency of 87.5%(21/24).No perioperative mortality or complication occurred.Conclusion detachable balloon technique is the optimal treatment for TCCF. For small fistula, detachable coils embolization are better.