Introduction Treatment of direct high-flow carotid-cavernous sinus fistulas (CCF) can be challenging. Treatment of CCFs with dual lumen balloons has not been described.
Purpose To describe two cases in which the CCF was effectively closed with a double lumen balloon.
Materials and methods Patient 1: a 19 year-old woman suffered a motorcycle accident 3 years ago. For the last 2 years she has noticed proptosis and chemosis of her right eye and continuous headaches. A diagnostic cerebral angiogram demonstrated a right direct CCF with proximal occlusion of the right internal carotid artery (Figure 1A). A scepter C balloon 4 x 15 mm was navigated through the right posterior communicating artery into the cavernous segment of the right internal carotid artery. The balloon was inflated and contrast was injected through the balloon to demonstrate the fistulous point. The balloon’s tip was then advanced into the cavernous sinus. Coils and onyx were placed/injected to occlude the fistula while the balloon was inflated (Figure 1B).
Patient 2: a 50 year-old man developed proptosis, chemosis and headaches after a car accident 1 month before consultation. A diagnostic cerebral angiogram demonstrated a direct high-flow CCF with complete steal phenomenon. A scepter C balloon 4 x 15 mm was positioned in the cavernous portion of the right internal carotid artery. The balloon was inflated and contrast was injected through the balloon to confirm the position of the fistulous point (Figure 2B). The tip of the balloon was used to access the cavernous sinus and place coils followed by the injection of onyx. The fistula was closed restoring antegrade flow through the carotid.
Results Two direct high-flow CCFs were successfully closed with a scepter balloon.
Conclusion Double lumen balloons like the scepter C can be used in the treatment of direct CCFs.
Disclosures E. Samaniego: None.
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