Comparison of the risk of oculomotor nerve deficits between detachable balloons and coils in the treatment of direct carotid cavernous fistulas.
OBJECTIVE
Transarterial balloon embolization used to be the preferred method for treating DCCFs; however, a strayed, overinflated, or migrated balloon may lead to oculomotor palsy. This investigation compared the use of detachable balloons and GDCs, which were previously used only in cases of balloon-technique failure and are now increasingly used as a first-line treatment for DCCFs, in terms of the risk of oculomotor nerve deficit, mortality/morbidity, and initial angiographic results.


METHODS
Among 48 patients with DCCFs treated with endovascular embolization at our institution between March 2004 and May 2009, 38 patients were included in this review. Patients who underwent trapping procedures, a second intervention within 2 weeks, or any procedure that included n-BCA infusion were excluded. Twenty of the enrolled patients were treated with transarterial balloons and the other 18, with GDCs.


RESULTS
Five patients (25%) in the balloon group and none in the coil group had oculomotor nerve deficits within 2 weeks. The rate of procedure-related oculomotor nerve deficit was significantly higher in the balloon group than in the coil group (P = .048). There were no significant differences in terms of procedure-related mortality/morbidity or initial angiographic results between the 2 groups.


CONCLUSIONS
The risk of procedure-related oculomotor nerve deficit in the treatment of DCCFs was significantly lower when using a GDC than with a detachable balloon. GDCs may, therefore, be considered as feasible, effective, and safe for DCCFs as detachable balloons.
Tsai
Y-H
YH
Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, College of Medicine and School of Medical Technology, Chang-Gung University, Chiayi, Taiwan.
Wong
H-F
HF
Weng
H-H
HH
Chen
Y-L
YL
D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002426:Cavernous Sinus / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D061220:Oculomotor Nerve Injuries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult