title: Endovascular embolization of recurrent traumatic carotid-cavernous fistulas managed previously with detachable balloons.
abstract: BACKGROUND
  This study investigated the causes of recurrent traumatic carotid-cavernous fistulas (RTCCFs) after detachable balloon embolization and evaluated the selection of embolic materials for endovascular treatment of the RTCCFs.
  
  
  METHODS
  Over a 10-year period, 116 patients underwent transarterial balloon embolization with occlusion of the fistulas and preservation of the parent arteries. In 15 patients, 18 RTCCFs developed. The causes of RTCCFs included premature balloon deflation and migration (n = 13) or bony fragment puncture of balloons (n = 5). A second or third embolization involved balloons (n = 6), balloons with coils (n = 2), and N-butyl-2-cyanoacrylate with coils (n = 7), or balloon, coils, and N-butyl-2-cyanoacrylate (n = 3).
  
  
  RESULTS
  In this study, 17 RTCCFs were successfully occluded after repeat embolization with preservation of parent arteries. One case resulted in recurrent epistaxis. The recurrent fistula and parent artery were occluded with balloons. No significant complications or recurrent fistulas occurred after the last embolization (mean follow-up period, 16 months).
  
  
  CONCLUSIONS
  Balloon puncture or premature deflation and migration occasionally cause RTCCFs. Sacrifice of the parent artery rarely is needed. Transarterial embolization remains the best approach, with balloons used first, then coils, N-butyl-2-cyanoacrylate, or both.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. cbluo@vghtpe.gov.tw
authors.forename: Chao-Bao
authors.initials: CB
authors.lastname: Luo
authors.forename: Michael Mu-Huo
authors.initials: MM
authors.lastname: Teng
authors.forename: David Hung-Tsang
authors.initials: DH
authors.lastname: Yen
authors.forename: Feng-Chi
authors.initials: FC
authors.lastname: Chang
authors.forename: Jiing-Feng
authors.initials: JF
authors.lastname: Lirng
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects; D020216:Carotid-Cavernous Sinus Fistula / Q000628:therapy*; D004659:Enbucrilate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012008:Recurrence; D019233:Retreatment; D014014:Tissue Adhesives / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate