This is a case of a direct carotid-cavernous fistula (CCF) where there is an abnormal connection (fistula) between the cavernous segment of the internal carotid artery and the cavernous sinus. After days of progressively worsening visual acuity and eye pain, close examination noted exophthalmos of the left eye. A CT angiography of the brain was ordered and opacification of the cavernous sinus and left superior ophthalmic vein were noted, concerning for a CCF. The patient had a digital subtraction angiography (DSA) where the CCF was confirmed. A stent was placed over the fistula which seemingly corrected normal antegrade blood flow through the internal carotid artery.

Several weeks following the procedure, the patient began to experience recurrent symptoms. An emergent DSA was performed which demonstrated recurrence of the CCF. Transarterial coil embolization was performed at that time.

The patient followed up with neurosurgery 2 months after the embolization and has symptomatically doing well. Follow-up CTA was negative for recurrence of the CCF.

CO-AUTHORS:
Chris McMahan
Joseph Giampa, DO
Allen Herr, MD