Balloon-Assisted Roadmap Technique to Enable Flow Diversion of a High-Flow Direct Carotid-Cavernous Fistula

The development of a high-flow carotid-cavernous fistula from the rupture of a large cavernous aneurysm successfully embolized by coils is rare. A 50-year-old male patient developed a high-flow carotid-cavernous fistula 48 hours after successful coiling of a large left cavernous aneurysm, presumably due to rupture of a focal dissection at or close to the neck of the aneurysm. He initially responded to daily self-compression of the left common carotid artery, but the fistula recurred. After failing to approach the fistula site via transvenous route, balloon trapping of the internal carotid artery was planned. Prior to its placement for functional occlusion test, the detachable balloon slipped into the fistula site and occluded it. It was thereafter detached in this position. The sequence of events, a large cavernous aneurysm spontaneous ruptured after coiling, suggested dissecting process or disease. We address in the report the complexity of the endovascular management of this rare association.

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XCalibur aneurysm occlusion device for the treatment of direct carotid cavernous fistula: expansion of armamentarium

BMJ Case Reports ◽

10.1136/bcr-2018-014475 ◽

2019 ◽

Vol 12 (2) ◽

pp. e014475 ◽

Cited By ~ 1

Author(s):

Shamick Biswas ◽

Nihar Vijay Kathrani ◽

Saini Jitender ◽

Arun Kumar Gupta

Keyword(s):

Flow Diversion ◽

Carotid Cavernous Fistula ◽

Complete Occlusion ◽

Cavernous Fistula ◽

First Case ◽

Occlusion Device ◽

Alternative Treatment Option ◽

Post Traumatic ◽

Aneurysm Occlusion ◽

Direct Carotid Cavernous Fistula

We report the first case of a post-traumatic direct carotid cavernous fistula (CCF) treated with the XCalibur aneurysm occlusion device, which is a balloon mounted stent with flow diversion effect. Two devices were deployed across the fistula in an overlapping manner, resulting in complete occlusion of the fistula. Flow diversion with this device can provide a safe and alternative treatment option in direct CCF.

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Spontaneous Resolution of Post-Traumatic Direct Carotid-Cavernous Fistula

Interventional Neurology ◽

10.1159/000480303 ◽

2017 ◽

Vol 7 (1-2) ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Varun Naragum ◽

Glenn Barest ◽

Mohamad AbdalKader ◽

Katharine M. Cronk ◽

Thanh N. Nguyen

Keyword(s):

Carotid Artery ◽

Endovascular Embolization ◽

High Flow ◽

Spontaneous Resolution ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Post Traumatic ◽

Cavernous Carotid Artery ◽

Carotid Cavernous Fistulas ◽

Direct Carotid Cavernous Fistula

Post-traumatic carotid-cavernous fistulas are due to a tear in the wall of the cavernous carotid artery, leading to shunting of blood into the cavernous sinus. These are generally high-flow fistula and rarely resolve spontaneously. Most cases require endovascular embolization. We report a case of Barrow type A carotid-cavernous fistula which resolved spontaneously.

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Low-Flow Direct Carotid-Cavernous Fistula Caused by Rupture of an Intracavernous Carotid Aneurysm

Interventional Neuroradiology ◽

10.15274/inr-2014-10057 ◽

2014 ◽

Vol 20 (4) ◽

pp. 476-481 ◽

Cited By ~ 2

Author(s):

I-Chang Su ◽

Juan Pablo Cruz ◽

Timo Krings

Keyword(s):

Rare Case ◽

High Flow ◽

Low Flow ◽

Clinical Scenario ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Carotid Cavernous Fistulas ◽

Direct Carotid Cavernous Fistula

Direct carotid-cavernous fistulas (CCFs) secondary to a ruptured intracavernous carotid aneurysm (ICCA) are usually high-flow lesions. On very rare occasions, a ruptured ICCA may present as a low-flow CCF, which poses a diagnostic and therapeutic dilemma whether the aneurysm and the observed fistula are causally related. Herein, we describe a rare case in which a ruptured ICCA resulted in a low-flow CCF. We demonstrated our approach to clarify this clinical scenario, and also propose a possible pathomechanism to explain the existence of low-flow direct CCF.

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