Direct puncture of a prematurely detached balloon in the supraclinoid ICA via the optic canal during embolisation of a traumatic carotid-cavernous fistula.
We report a patient with traumatic carotid-cavernous fistula associated with an isolated internal carotid artery in whom, after trans-arterial balloon embolisation, premature balloon detachment occurred with balloon migration to the supraclinoid carotid artery, leading to total occlusion of the blood flow. The carotid flow was eventually restored by direct puncture of the detached balloon via the optic canal and by deploying a coronary stent to fix the balloon in the vascular wall. The fistula was eventually occluded by using detachable coils. He was discharged with a mild hemiparesis and decreased acuity in the left eye.
Department of Radiology, Taipei Veterans General Hospital and National Yang Ming University School of Medicine, 201, Sec 2, Shih-Pai Road, Taipei, Taiwan, Republic of China. cbluo@vghtpe.gov.tw
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Teng
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Chang
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Chang
D000063:Accidents, Traffic; D000328:Adult; D017130:Angioplasty / Q000295:instrumentation / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D021721:Balloon Occlusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D020212:Carotid Artery Injuries / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016893:Carotid Stenosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D020216:Carotid-Cavernous Sinus Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D005548:Foreign-Body Migration / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D009049:Motorcycles; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012086:Reoperation; D013100:Sphenoid Bone / Q000033:anatomy & histology / Q000601:surgery; D015607:Stents; D013525:Surgical Instruments / Q000009:adverse effects*; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors