Comparison of the risk of oculomotor nerve deficits between detachable balloons and coils in the treatment of direct carotid cavernous fistulas

Abstract

Background and purpose: 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.

Materials and 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.