Interventional radiologic techniques with trans-arterially deployed detachable balloon
embolization and maintenance of patent ICA is the gold standard in managing traumatic CCF (Close hole, keep artery open), but in some cases carotid sacrifice may be needed to occlude the fistula.
With advances in neuroendovascular techniques and materials, a mounting body of endovascular treatment options for direct CCFs, such as coils, detachable balloon
, stents, and liquid embolic agents, are available by transarterial or transvenous embolization.
Use of a detachable balloon
would have been better suited in this case, owing to the tortuosity of the dysplastic right vertebral artery allowing better passage of the delivery system; however, detachable balloons
were not available at our institution at the time of this procedure.
Endovascular detachable balloon
embolization therapy of cavernous carotid artery aneurysms: results in 87 cases.
(4) Similarly, other authors have described balloon test occlusion followed by detachable balloon
embolization or vessel ligation for these patients.
There are a variety of surgical methods of repairing cerebral aneurysms, including surgical clipping and detachable balloon
Balloon occlusion has become an accepted modality of treating traumatic carotid-cavernous fistulas (CCF).8,9 Our study found that six cases of CCF had been successfully treated with transcatheter detachable balloon
A 8.5 mm detachable balloon
(GVB 17, Minvays, Gennevielles, France) was introduced and placed at the fistulous site just proximal to the vascular curve.
A 6 Fr guiding catheter (MPD, Cordis corporation) was placed in internal carotid artery close to the fistula and the fistula was tried to cross with a micro-catheter (Minitorque KTC 150 Minvasys) mounted with a detachable balloon
(GoldValve, CathNet-Science, Paris, France) once the fistula was successfully crossed, the balloon was inflated in cavernous sinus and fistula was closed (Figure-1).
The embolic agent's segment is further sub-segmented into embolic coils, embolic plug systems, liquid embolic agents, microspheres, and detachable balloons
. Whereas, the support devices segment includes microcatheters and guidewires.
Among the various devices, few are detachable balloons
, coils, controlled release coils and patent ductus arteriosus devices.
Endovascular methods, including the use of detachable balloons
, liquid agents, coils, and stent grafts, have greatly enhanced the success and safety of treating AVFs.