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

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.