Objective: To explore the causes and countermeasures of refractory carotid-cavernous fistula (CCF).
Methods: Twelve refractory cases from 123 cases of consecutive traumatic CCF during 12 years were reviewed.
Results: The main causes of refractory CCF were: small or large fistula's opening, or constrictive parent artery; inappropriate early treatments such as ligature of internal carotid artery or common carotid artery, balloon detachment of, and non-dense packing of coils inside the cavernous sinus; unexpected deflation or balloon displacement of resulting in fistula recurrence. Anatomical cure was achieved in 11 cases, and clinical care in 1 by using balloon or/and coil or/and NBCA (n-butal 2-cyanoacrylate) through arterial, venous or surgical approach.
Conclusions: refractory CCF can be treated effectively skilled catheterization and embolization as well as appropriate approach and embolic material according to fistula structure and vascular route.