title: Transarterial balloon-assisted n-butyl-2-cyanoacrylate embolization of direct carotid cavernous fistulas.
abstract: OBJECTIVE
  Transarterial detachable balloon embolization of direct carotid cavernous fistulas (DCCFs) has become an optimal treatment. In a few cases, the parent artery has to be sacrificed to achieve morphologic cure. We present our experience with transarterial balloon-assisted n-butyl-2-cyanoacrylate (n-BCA) embolization of DCCFs in which there was failure to achieve angiographic cure and preservation of parent arteries.
  
  
  METHODS
  Of 141 patients with traumatic DCCFs who had been treated by transarterial embolization with occlusion of the fistula and parent artery preservation, 18 received transarterial balloon-assisted n-BCA embolization-6 for residual fistula after the balloons detached, 7 for recurrent fistula because of premature balloon deflation or migration, and 5 for repeated puncture of the detachable balloon by the bony fragment at the cavernous sinus. A total of 27 procedures were performed with an average 1.5 attempts per patient, and the volume of the n-BCA mixture varied from 0.5 to 2.3 mL with a mean of 0.83 mL.
  
  
  RESULTS
  All DCCFs were successfully occluded by the n-BCA mixture with preservation of parent arteries. One patient with a giant cavernous sinus varix had a fatal subarachnoid hemorrhage. One had a recurrence and was treated by internal carotid artery (ICA) occlusion. Five had asymptomatic pseudoaneurysms at the parent artery. There was no adhesion of the n-BCA mixture to the protective balloon or the microcatheter or n-BCA reflux into the parent arteries.
  
  
  CONCLUSIONS
  Transarterial balloon-assisted n-BCA embolization is a feasible, efficient, and safe treatment for DCCFs when angiographic cure and ICA preservation are not achieved by transarterial detachable balloon embolization.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, No. 201 Section 2 Shih-Pai Road, Beitou, Taipei 112, Taiwan, R.O.C. cbluo@vghtpe.gov.tw
authors.forename: C-B
authors.initials: CB
authors.lastname: Luo
authors.forename: M M H
authors.initials: MM
authors.lastname: Teng
authors.forename: F-C
authors.initials: FC
authors.lastname: Chang
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chang
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000209:etiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D019233:Retreatment; D012449:Safety; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014014:Tissue Adhesives / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014648:Varicose Veins / Q000628:therapy
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate