title: A comparison of different transarterial embolization techniques for direct carotid cavernous fistulas: a single center experience in 32 patients.
abstract: OBJECTIVE
  Transarterial treatment of direct carotid cavernous fistulas (DCCF) via embolic materials has been well documented. This study reports, validates, and compares with existing literature our experience treating DCCFs via endovascular approaches by using detachable balloons, coils, and covered stents.
  
  
  METHODS
  Between June 2006 to October 2011, 32 patients (21 male, 11 female) with 32 DCCFs (30 traumatic, 2 spontaneous cavernous ICA aneurysms) were embolized endovascularly. Followup was performed for at least 6 months.
  
  
  RESULTS
  Among the 32 DCCFs, 21 (65.6%) were embolized using detachable balloons, eight (25.0%) with coils, one (3.1%) with balloons and coils, and two (6.3%) with covered stents. Complete DCCF obliteration was achieved in 31 (96.9%) cases. One fistula failed to respond due to premature balloon detachment. Intracranial bruit in 31 (100%) chemosis and exophthalmos in 28 (100%) cases resolved after embolization. Visual acuity and oculomotor palsy improved in 18 (90%) and 18 (69.2%) cases, respectively. There was no evidence of DCCF recurrence. Thirteen DCCFs were followed up by MRI and five by DSA. In these cases, four (4/13, 30.8%) balloon-embolized DCCFs showed pseudoaneurysms. Three patients were asymptomatic; one had minor left oculomotor palsy.
  
  
  CONCLUSIONS
  Our results correlate and reinforce literature regarding endovascular treatment of DCCFs. Application of Transarterial embolization with detachable balloons, despite extensive use has been decreasing. Coil embolization is an effective and safe alternative for treatment, especially when balloon embolization fails. Covered stent placement may be used as another alternative for selected cases.
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China.
authors.forename: Xiaojian
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Neurosurgery, Wayne State University, Detroit, MI, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hussain
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China.
authors.forename: Lanchun
authors.initials: L
authors.lastname: Ni
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China.
authors.forename: Qinfeng
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Zhou
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China.
authors.forename: Zhikai
authors.initials: Z
authors.lastname: Gu
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong 226001, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Wayne State University, Detroit, MI, USA.
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Shanghai 200040, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
keywords: Carotid cavernous fistula; coil; covered stent; detachable balloon; embolization