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FIG 3. Forty-four-year-old man (case 14 [Table 1]) develops a slowly progressive bilateral chemosis and proptosis. A transvenous n-BCA embolization combined with platinum coils was carried out with successful CCF obliteration and clinical recovery.
A–J, Early and late right ICA lateral (A and B), right ECA frontal (C and D), left ICA frontal and lateral (E–I), and left ECA frontal (J) angiograms show a CCF with mixed bilateral (left > right) dural artery supply via both ECA and ICA (A, B, E, F, G, arrows, Type D-2, ref. 2). There is an early venous drainage via both IPS (D, arrows; I, double arrow), both SOVs (right > left; I, small arrowheads), and the right sphenoparietal vein (F, H, I, arrowheads). Marked dilation of the right CS segment as compared with the left (F and H, small arrows) with prominent "radiolucent" ICA boundaries (F and J).
K and L, Superselective catheterization of the left CS segment through the right IPS and microcatheter tip placement into the anterior-medial segment (arrow). The microcatheter injection shows retrograde filling of both congested SOVs (small arrowhead and small arrows) and the right sphenoparietal vein (arrowheads).
(Continued)M, The microcatheter tip is placed further into the left common ophthalmic vein (arrow).
N, Placement of platinum coils into the common ophthalmic vein (arrow) and cavernous sinus to reduce flow in CS and protect acrylate spillage.
O, Microcatheter control angiography shows filling of the cavernous sinus and the common ophthalmic vein (arrow), but sparse filling of SOV.
P and Q, Acrylate infusion under plain roadmap with casting of the cavernous sinus. Note n-BCA is contained within the coil mass, no spillage into SOV (arrows).
R–X, Bilateral ICA and ECA early and late control angiography shows CCF obliteration with antegrade filling of the sphenoparietal vein and slow outflow (V, arrowheads).
(Continued) Y and Z, Chemosis and conjunctivitis before treatment. Near-complete resolution 2 weeks after CCF obliteration.
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