Study On The Clinical Efficacy And Risk Factors Of Recurrence Of Detachable Balloon Embolization In The Treatment Of Traumatic Internal Carotid Cavernous Fistula

Objective:To explore the clinical efficacy,safety,reliability and recurrence rate of detachable balloon embolization in the treatment of Traumatic carotid cavernous fistula,focus on the analysis of the risk factors for recurrence of TCCF,and provide theoretical guidance for clinical treatment.Methods:Forty-nine TCCF patients treated with detachable balloon embolization in the Department of Neurosurgery,General Hospital of Central Theater Command from October 2011 to October 2020,were retrospectively analyzed.Data collected from each patient included clinical data,treatment results,recurrence rate and post-recurrence treatment,systematically summarize,analyzed,evaluated the clinical efficacy,safety,reliability,and recurrence of detachable balloon embolization in the treatment of TCCF Rate,analyzed and discussed the risk factors of TCCF recurrence after detachable balloon embolization.According to the recurrence during follow-up,patients were divided into recurrence group and non-recurrence group.All statistical data were processed by statistical software SPSS 25.0.First,single-factor analysis was performed to screen out insignificant variables,and then meaningful variables in single-factor analysis were included in the Logistic regression equation for analysis.P<0.05 indicated statistical significance.Results:Among the 49 TCCF patients included in the criteria,34 cases were males and 15 cases were females,ranging in age from 24 to 75 years old.Among them,34 cases of TCCF were treated with one balloon embolization,and 15 cases of TCCF were embolized with multiple balloons(2 or more).The fistula was occluded and the internal carotid artery was retained in 43 cases,and the internal carotid artery was occluded in 6 cases.There were 8 recurrent cases in the past follow-up,with a recurrence rate of 16.3%,which occurred in 2 to 18 days after detachable balloon embolization,with an average of(7.38±5.76)days.Univariate analysis showed that the recurrence rate of TCCF with fistula at different positions of internal carotid artery after detachable balloon embolization was significantly different(P<0.05).Multivariate analysis showed the location of the fistula in the curved segment of the internal carotid artery was identified as an independent risk factor for recurrence of TCCF after detachable balloon embolization(HR:12.93,95%CI:1.83-91.46;P<0.05).Conclusion:The use of detachable balloon embolization of TCCF had the characteristics of high curative effect,high safety,and easy operation.However,the patency rate of the internal carotid artery had not yet reached 100%,and it has a certain complication and recurrence rate.In our hospital,detachable balloon embolization is still the first choice for retreatment of recurrent TCCF.However,after the recurrence of TCCF,due to the premature leakage or displacement of the balloon in the cavernous sinus,it may be difficult for the re-treatment balloon to enter the cavernous sinus completely through the fistula.Re-treatment may require embolization materials such as coils,liquid glue,stent grafts,or occlusion of the internal carotid artery to treat TCCF.Detachable balloon treatment of TCCF had a high recurrence rate within 2 weeks,and The fistula located in the curved segment of the internal carotid artery was an independent risk factor for recurrence of TCCF after detachable balloon embolization.