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Endovascular Trapping of Traumatic Carotid-Cavernous Fistulae

Stuart C. Coleya, Hament Pandyaa, Tim J. Hodgsona, Martin A. Jeffreeb and Neil P. Deasyb

a Department of Radiology, Royal Hallamshire Hospital, Sheffield, England
b Department of Neuroradiology, Kings College Hospital, London, England



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  		FIG 1. A, Preoperative sagittal T1 MR image demonstrates a flow void corresponding to a large vascular compartment and a massive high signal intensity "mucocele." Compare the black flow void with the lateral angiogram (B).

B, Preoperative lateral catheter arteriogram (left ICA). Early arterial phase shows the carotid artery terminating in an enlarged venous compartment.

C, Preoperative lateral catheter arteriogram (left ICA). Later arterial phase shows rapid arteriovenous shunt surgery into the ophthalmic, petrosal, and cortical veins

D, Frontal arteriogram (right ICA) following proximal balloon occlusion of the left carotid artery shows rapid filling of the fistula by retrograde flow.

E, Frontal arteriogram (right ICA) following coil embolization of the distal (L) carotid artery. The coils were deployed through a microcatheter that had been advanced from the right carotid artery into the left carotid via the anterior communicating artery.

F, Lateral arteriogram (left vertebral artery) following proximal balloon and distal coil trapping of the massive fistula. There is no compromise of the collateral circulation from the posterior circulation. Antegrade flow is restored within the left carotid artery via the posterior communicating artery.

G, Postoperative dynamic (1 frame/s) contrast-enhanced MR image shows isolation of the fistula and complete opacification of the left cerebral hemisphere. Six-month arteriogram (not shown) confirmed complete closure of the fistula.



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  		FIG 2. A, Late phase of right internal carotid arteriogram. There is a large carotid-cavernous fistula with multidirectional venous outflow into the ophthalmic, cortical, petrosal, and pterygoid venous systems.

B, Lateral vertebral arteriogram following proximal balloon occlusion of the right ICA. There is rapid filling of the fistula via the posterior communicating artery.

C, Lateral vertebral arteriogram following proximal balloon occlusion and distal coil embolization of the right ICA, the latter performed via the posterior communicating artery. The fistula is closed.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X