Endovascular embolization of refractory traumatic carotid cavernous fistula with micro-coils: a preliminary experience.

AIM This study reports our preliminary experiences in performing detachable micro-coils embolization for refractory traumatic carotid cavernous fistulas (TCCFs) and evaluates its efficacy and safety. MATERIAL AND METHODS Fifteen consecutive patients with TCCFs treated with detachable micro-coils after initial failure of detachable balloons embolization are presented. RESULTS The fistulas were successfully occluded along with preservation of internal carotid artery (ICA) in 14 cases. However, the fistula and ICA were finally occluded with balloons in one case. The micro-coil got unraveled in one case, and the unraveled part had to be pulled into and fixed to the external carotid artery. All patients have undergone clinical and angiography follows up for a median duration of 22 months (range, 14 to 48 months). The clinical symptoms and signs related to fistulas such as proptosis, bruit, chemosis and headache gradually decreased after endovascular treatment in 14 cases, and only one case recurred after 2 weeks. CONCLUSION Micro-coils embolization is a safe and reliable strategy in refractory TCCFs that could not be managed by using detachable balloons. It may not be possible to densely pack the cavernous sinus, and subtotal packing also effectively occludes the fistula and alleviates the patient's symptoms.