A novel approach to direct carotid cavernous fistula repair: HydroCoil-assisted revision after balloon reconstruction.

Background: Direct carotid cavernous fistulae (CCF) are commonly treated by endovascular deployment of a detachable balloon into the cavernous sinus to reconstruct the sidewall of the carotid artery and preserve flow in that vessel. Relatively few reports exist describing revisions using constructive, transarterial approaches when this technique fails.
Methods: We describe a novel method using expandable hydrogel-coated platinum coils to revise a failed balloon reconstruction in which the balloon had migrated within the cavernous sinus away from the rent in the carotid wall.
Results: This new technique to buttress the balloon back into the desired position using expandable coils proved to be effective, safe, and durable.
Conclusions: As endovascular treatments for direct CCF continue to evolve, techniques for revision will likely follow. This report adds a novel approach to our therapeutic armamentarium.