Treatment of carotid cavernous fistulas: a new balloon delivery system.

Direct carotid cavernous fistulas (CCFs) have been successfully treated with detachable flowdirected balloons for many years (1 , 2). However, there remains a significant number of fistulas that cannot be entered with these flow-directed balloons. Usually this is because the fistula orifice is small or the orifice is located at such an angle to preclude balloon entry. In such instances, difficult transvenous approaches may be attempted (3). In other cases, carotid occlusion may be the only alternative, and has been reported in 20%-60% of cases (2, 4, 6). Recently, we began using a