HydroCoil occlusion for treatment of traumatic carotid-cavernous fistula: preliminary experience

Objective

To summarize our preliminary experiences regarding HydroCoil occlusion for the treatment of carotid-cavernous fistula (CCF), and to evaluate the effectiveness of this treatment.

Methods

From January 2006 to June 2007, 15 patients with traumatic CCF who were treated using HydroCoil occlusion were included in this study. All the patients presented with symptoms such as intracranial pulsatile noise, bulbar conjunctival hyperemia, and pulsatile exophthalmia. Cerebral angiography revealed that the fistula was located in the right internal carotid-cavernous segment in 6 cases, in the left internal carotid-cavernous segment in 8 cases, and on both sides in 1 case.

Results

After CCF procedure, in 15 patients, the fistula was no longer visualized, the internal carotid artery on the affected side remained patent, and intracranial noise disappeared immediately. The preoperative symptoms exophthalmia, bulbar conjunctival hyperemia, etc., returned to normal 1 week after the operation. Vision recovered to varying extents. In the 9 patients who underwent 1-3 months of follow-up cerebral angiography, CCF recurrences and neurological complications were not observed.

Conclusion

Intravascular occlusion has been widely used for CCF treatment, and detachable balloon embolization remains the preferred treatment. In the case of failure of detachable balloon embolization because the patient cannot tolerate the procedure or internal carotid artery occlusion on the affected side is contraindicated, HydroCoil occlusion is a safe and effective though expensive alternative and a stable method of maintaining high carotid artery patency.