LONG-TERM RESULTS IN DIRECT CAROTID-CAVERNOUS FISTULAS AFTER TREATMENT WITH DETACHABLE BALLOONS

Transarterial embolization of direct carotid-cavernous fistulas (CCFs) using detachable balloons is the best initial option for occlusion of the fistula and preservation of the internal carotid artery. However, the long-term safety and efficacy of this treatment is unknown. The a uthors reviewed the long-term outcome of 87 patients with 88 direct CC Fs occluded by detachable balloons. Clinical follow up was obtained in 48 (83%) of 58 patients treated with latex balloons ( mean follow-up period 10 years, range 5.9-15.5 years) and 28 (97%) of 29 patients tre ated with silicone balloons (mean followup period 4 years, range 1-6.6 years). Two patients were treated with both balloon types. There were no late recurrent symptoms of cranial bruit, proptosis, chemosis, or arterialized conjunctiva in patients treated with either latex or sili cone balloons. Diplopia improved in all patients; however, five patien ts required shortening of the lateral rectus muscle. Delayed ischemia occurred in three patients: one patient had a transient ischemic episo de 5 years after treatment with latex balloons and two patients (85 an d 90 years old) who had ruptured spontaneous intracavernous aneurysms suffered cerebral infarctions 6 weeks and 4 months, respectively, afte r treatment with silicone balloons. There were five deaths in the seri es unrelated to balloon treatment. These results show that after trans arterial embolization of direct CCFs using either silicone or latex de tachable balloons, the long-term risks are low for fistula recurrence, symptomatic foreign body reaction, symptomatic pseudoaneurysm formati on, and cerebral ischemia.