Transvenous Target Embolization for a Small Sized, Non-traumatic Direct Carotid-cavernous Fistula using a Single Coil: Technical Case Report

Abstract

Purpose:We report on a patient who underwent transvenous target embolization of a small, direct carotid-cavernous fistula (CCF). Case:A 74-year-old female without a history of trauma was referred to our department. Tinnitus and ocular symptoms initially occurred as symptoms of a right, direct CCF. Anterograde blood flow at the peripheries of the anterior and middle cerebral arteries was maintained, and an Allcock test confirmed a fistula connecting from the C3 region of the internal carotid artery to the cavernous sinus. Transvenous target embolization of the fistula was performed while protecting the internal carotid artery using a balloon. The use of only a single coil led to the disappearance of the shunt. Conclusion:In some patients, a small, direct CCF can be cured by target embolization. It is important to predict the size of a fistula and clearly visualize the fistulous site in the process of diagnosis.

Carotid-cavernous Fistula Associated with a Ruptured Persistent Primitive Trigeminal Artery Aneurysm: A Case Report and Review of Literature

“…However, this strategy is available in the case with small fistulas. 16) In our case, the precise dome and neck of the aneurysm were not identified, and the size of fistulas was not identified either. Thus, after the aneurysm including the fistulas was partially occluded, parent artery occlusion of the PPTA was performed.…”

“…Transarterial embolization using detachable coils or liquid embolic agents is more recommended than transvenous embolization as embolization of the aneurysm sac by a transvenous approach is difficult, and transvenous CS packing with detachable coils may require a large number of coils and worse ocular symptoms. 15) Target transvenous and/or transarterial embolization is useful as a treatment option even in the CCF, 16 , 17) which prevents the complications of neurological symptoms caused by the CS packing and sacrifice of PPTA. However, this strategy is available in the case with small fistulas.…”

Target Coil Embolization Using the Combined Transarterial and Transvenous Balloon-assisted Technique for Traumatic Direct Carotid Cavernous Fistula

“…The case of transvenous coil embolization with transarterial balloon-assisted technique during target embolization for DCCF has been reported. 20) However, coil embolization with double catheter technique from arterial and venous both sides during target embolization for DCCF has not been reported. In this case, the treatment in only double catheters was useful and safe; in fact, we performed the transvenous balloon-assisted technique for rescue because the filling coil migrates easily to the outside of the frame.…”