Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study

Table 1 Commonly used detachable balloons in the present study

Balloon size	Maximum volume in mL	Inflated dimensions in mm, diameter × length
GOLDBAL 4	0.75	9 × 16
GOLDBAL 5	2.50	12 × 28
GOLDBAL 6	3.00	15 × 25
GOLDBAL SP	0.90	12 × 13

Table 2 Summary of the 79 patients treated with transarterial balloon embolization

Patient characteristics	Number of patients, n (%)
Sex
Male	56 (70.9)
Female	23 (29.1)
Cause of injury
Motor vehicle accident	75 (94.9)
Assault	2 (2.5)
Falling from height	1 (1.27)
Gunshot wound	1 (1.27)
Symptoms
Pulsatile proptosis	61 (77.2)
Conjunctival chemosis	39 (49.4)
Red eye	49 (62.0)
Tinnitus	28 (35.4)
Visual impairment	9 (11.4)
Cranial nerve palsy	8 (10.1)
Hemiparesis	2 (2.5)
Fistula characteristics
Side
Right	40 (50.6)
Left	39 (49.4)
Location
C1	1 (1.3)
C2	7 (8.9)
C3	26 (32.9)
C4	25 (31.6)
C5	20 (25.3)
Size
Small	14 (17.7)
Medium	31 (39.2)
Large	34 (43.1)
Result of treatment
Number of balloons used
One	51(64.6)
Two	20 (25.3)
Three	8 (10.1)
Recurrence of fistula	13 (16.5)
ICA preservation	73 (92.4)
The occurrence of pseudoaneurysm
Grade 0-No pseudoaneurysm	24 (32.9)
Grade 1-Small pseudoaneurysm	22 (30.1)
Grade 2-Medium pseudoaneurysm	18 (24.7)
Grade 3-Large pseudoaneurysm	9 (12.3)
Grade 4-Giant pseudoaneurysm	0 (0)

ICA: Internal carotid artery.

Table 3 Comparison of balloon size and pseudoaneurysm grade, n (%)

Balloon size	Pseudoaneurysm grade				P value
	0	1	2	3
No. 4	1 (16.7)	4 (66.6)	1 (16.7)	0 (0.0)	0.348
No. 5	2 (13.3)	7 (46.7)	4 (26.7)	2 (13.3)	0.233
No. 6	2 (15.4)	2 (15.4)	3 (23.1)	6 (46.1)	0.002a
SP	19 (44.2)	12 (27.9)	11 (25.6)	1 (2.3)	0.005a

^aP < 0.05.

Table 4 Comparative therapeutic outcomes in patients harboring traumatic carotid-cavernous fistula treated with transarterial detachable balloon embolization from different centers

Ref.	Total cases	Total fistula treated with DB	Balloon type	Preservation of ICA (%)	Recurrence (%)	Pseudoaneurysm (%)	Other balloon-related complications (n)
Debrun et al[12], 1981	54	54	Latex	59.0	9.3	44.0	Transient oculomotor nerve palsy (11)
Tsai et al[13], 1983	58	43	Latex	N/A	2.3	32.5	Migration of deflated balloon into the ICA (2); delayed stroke (1)
Berthelsen and Svendsen[14], 1987	14	10	Latex	N/A	21.4	N/A	Transient ischemic attack (1); migration of balloon into MCA (1)
Higashida et al[26], 1989	206	206	Silicone	88.0	0	2.4	Oculomotor nerve palsy (1); ischemic stroke (5)
Lewis et al[27], 1995	100	88	Latex/Silicone	75.0	5.7	N/A	Transient ischemia episodes (3); death (1)
Wu et al[28], 2000	482	471	Latex	84.0	3.3	N/A	Cerebral infarction (2); vision loss (1)
Luo et al[29], 2004	143	143	Latex	81.0	11.2	N/A	N/A
Szkup and Beningfield[30], 2005	34	34	Latex	53.0	N/A	N/A	Transient hemiparesis (1)
Gupta et al[31], 2006	89	79	Latex	98.0	0	N/A	Transient cranial palsy (1)
Wang et al[22], 2011	51	44	Latex	85.0	11.4	18.2	None
Malan et al[25], 2012	32	17	Latex	66.0	15.6	N/A	Balloon displacement (3); balloon rupture or deflation (8)
Xu et al[32], 2013	58	58	Latex	87.9	12.1	N/A	None
Chi et al[20], 2014	172	138	Latex	70.0	9.8	N/A	Transient hemiparesis (1); transient oculomotor nerve palsy (1); vagal shock, death (1)
Gao et al[21], 2018	188	182	Latex	85.7	13.9	N/A	Cerebral embolism (1); abducent nerve paralysis (2)
Niu et al[19], 2020	24	21	Latex	90.4	8.3	4.2	Oculomotor and abducens nerve palsy (1); abducens nerve palsy (1)
Present study	79	79	Latex	92.4	16.5	67.1	Early detachment and migration of balloon (1); transient oculomotor nerve palsy (3)

DB: Detachable balloon; ICA: Internal carotid artery; N/A: Data not applicable; TCCF: Traumatic carotid-cavernous fistula; MCA: Middle cerebral artery.