Comparison of covered stents with detachable balloons for treatment of posttraumatic carotid-cavernous fistulas

Abstract

Treatment of posttraumatic direct carotid-cavernous fistula (DCCF) with detachable balloons (DB) is associated with relatively low complete occlusion rates. We aimed to compare the angiographic and clinical results of treatment with covered stents with the results of treatment with DB. Thirty-four patients with posttraumatic DCCF were selected for treatment with DB (n=19, group A) or covered stents (n=15, group B). Data on the technical success, duration of initial procedure and hospital stay, initial and final angiographic results, mortality, morbidity and final clinical outcomes were collected and analyzed within 12months. DB deployment and covered stent placement were technically successful in all patients, except one patient in group B in whom the covered stent failed to navigate to the target DCCF. The initial angiographic results for the 33 patients with successful procedures showed complete occlusion in 16 patients in group A (84.2%; 95% confidence interval [CI]: 66%, 102%) and 11 patients in group B (78.6%; 95% CI: 54%, 103%; p>0.05). The 12-month angiographic results indicated complete occlusion in 12 patients in group A (63.2%; 95% CI: 39%, 87%) and 14 patients in group B (100%; p=0.013). The average initial procedure time was 120.0±17.76minutes in group A and 93.15±8.12minutes in group B (p<0.001). No significant differences were seen between the two groups in technical success, mortality, morbidity or final clinical outcomes. In this nonrandomized, prospective study of posttraumatic DCCF treatment, the 12-month angiographic results of treatment with covered stents was superior to that of BD.