Deconstructive repair of a direct carotid-cavernous fistula via a posterior circulation retrograde approach

Author: Jonathan R. CROWE ¹ ; Robert W. REGENHARDT ; Adam A. DMYTRIW ; Justin E. VRANIC ; Christopher J. STAPLETON ; Aman B. PATEL
Author Information

1. Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA
Publication Type:Case Report
From:Journal of Cerebrovascular and Endovascular Neurosurgery 2024;26(4):394-398
CountryRepublic of Korea
Language:English
Abstract: We report a case of a 24-year-old patient who presented after a head trauma with a traumatic occlusion of his left internal carotid artery. He underwent diagnostic cerebral angiogram and was found to have a direct left carotid-cavernous fistula (CCF) with retrograde filling from the posterior circulation across the posterior communicating artery. Because of the severe injury to the left internal carotid artery (ICA), reconstructive repair of the ICA was not possible. The patient underwent deconstructive repair of the CCF by coil embolization using a posterior retrograde approach. Coils were successfully placed in the cavernous sinus and back into the left ICA with complete cure of the CCF and restoration of cerebral perfusion distal to the treated CCF. We review the types of CCFs, their clinical presentation, and their endovascular treatments. Retrograde access of a direct CCF is rarely reported in the literature, and we believe this approach offers a viable alternative in appropriately selected patients.