Transvenous Coil Treatment of a Type A Carotid Cavernous Fistula in Association with Transarterial Trispan Coil Protection
Luca Remondaa,
Susanne Beatrice Frigeriob,
Robert Bühlerb and
Gerhard Schrotha
a Department of Neuroradiology, University of Bern, Inselspital, Bern, Germany
b Department of Neurology, University of Bern, Inselspital, Bern, Germany
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FIG 1. Coronal reconstruction of a contrast-enhanced CT scan showing the large tear between the aneurysmatic fusiform dilatation of the ICA and the cavernous sinus.
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FIG 2. Biplane digital subtraction angiography of the left ICA showing the high-flow CCF with drainage into the inferior petrosal sinus, the ophthalmic vein, and the contralateral side in anteroposterior (A) and lateral view (B).
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FIG 3. Unsubtracted view of the left ICA showing the position of the balloon extending from the medial wall of the cavernous sinus to the lateral and dorsal wall of the aneurysm (A) confirmed by CT scan 1 day later (C), whereas the subtracted anteroposterior view confirms preservation of the parent artery and occlusion of the fistula (B).
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FIG 4. Nonsubtracted oblique view (A) showing the transarterially introduced microcatheter with the neck-bridging device between the CS and ICA (heavy arrows) and the transvenously introduced microcatheter during packing of the CS (thin arrows). Corresponding digital subtraction angiography confirms the protected ICA and dense packing of the CS compartment directly adjacent to the ICA-CS tear with occlusion of the fistula (B).
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FIG 5. Drawing of the neck-bridging TriSpan coil showing the three nitinol loops, partly covered by platinum to increase radiopacity, fixed together at their struts and the detachment zone at the end of the pusher wire.
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