Endovascular treatment of traumatic direct carotid cavernous fistulas with n-Butyl-2-Cyanoacrylate

Abstract

Objective To explore the method and safety of endovascular treatment of traumatic direct carotid cavernous fistulas with n - Butyl - 2 - Cyanoacrylate. Method A total of 11 patients with traumatic direct carotid cavernous fistulas treated by endovascular embolization with n - Butyl -2 - Cyanoacrylate( n - BCA ) were retrospectively analyzed, including the clinical presentations, methods of treatment and results of follow - up. Results In the 11 patients treated with n - BCA embolization, 3 with recurrent fistula because of premature balloon deflation or migration,4 with residual fistula after the balloons or microcoils detached, 3 unable to guide balloon into the small fistulous orifice and 1 repeated puncture of the detachable balloon by the bony fragment. The concentration of n - BCA ranged from 25% to 50%,protective balloon was used in 4 cases and there was no adhesion fo the n - BCA to the protective balloon or the microcatheter or n - BCA reflux into the parent arteries. Complete angiographic obliteration was documented in all patients right after the embolization. There was no permanent procedure - related morbidity. Clinical cure was achieved in all case and the clinical follow - up period ranged from 3 months to 5 years, all the patients restored to their normal life. Conclusions Endovascular embolization with n - BCA is a safe,efficient method for the treatment of traumatic direct carotid cavernous fistulas when angiographic cure and parent artery preservation are not achieved by detachable balloon embolization. Key words: Embolization; Carotid cavernous fistulas; Glue; Trauma