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Carotid-Cavernous Fistula - Treatment by Endovascular Techniques (Embolization)

Case Example:

A carotid-cavernous fistula is a vascular disorder in which a patient suffers from an abnormal communication between the carotid artery (one of the main arteries to the brain) and the cavernous sinus- a venous structure from which blood drains from the eyes and the brain. The abnormal communication can occur spontaneously, or from trauma. This abnormality causes the blood from the artery to be transmitted to the veins of the eye and/or the brain. This causes the patient to have a red, bulging eye, can result in a loss of vision, and sometimes in a brain hemorrhage.

Treatment of a carotid-cavernous fistula used to be with open brain surgery. However, modern neurointerventional techniques have all but eliminated the need for open surgery. These lesions are now successfully treated at our institution with endovascular methods as shown in this case. The tear between the artery and the vein is best closed through the blood vessels themselves by placing either balloons or coils into the abnormal communication, obviating the need for surgery. Preservation of the carotid artery is ideal but not always feasible.

Pre-Treatment:

Seventy year old man who presented with a swollen, red eye 1 month after a car accident. A Carotid angiogram shows a hole between the carotid artery and the cavernous sinus (red arrow), which resulted in the drainage of arterial blood towards the eye (blue arrow).

   

Treatment:

Traveling through the arteries a catheter (small tube) was placed through the hole into the cavernous sinus (arrow).

   

Coils (arrow) were deposited into the cavernous sinus to close the hole.

   

Post-Treatment:

Post treatment angiogram shows that the hole is closed and the carotid artery is open.