Article Figures & Data
Figures
- Fig 1.
A and B, Anteroposterior and lateral projections of the left common carotid artery demonstrate an indirect dAVF involving the cavernous segment (solid black arrow). C, Selective left internal carotid artery injection on lateral projection further elucidates this finding (solid black arrow) with venous drainage to the left petrosal sinus. D and E, Anteroposterior and lateral projections of a selective right external carotid artery injection show no filling of the fistula from external carotid branches. F, Selective right internal carotid injection in a lateral projection reveals a tear in the vessel at the cavernous segment (dashed black arrow). G, Anteroposterior view of a right internal injection shows the presence of a markedly engorged left superior ophthalmic vein (white arrow) that is the cause of the patient’s symptoms.
- Fig 2.
A, Selective run through the direct fistula (black arrow) of the right cavernous sinus is shown with venous drainage to the petrosal and transverse sinuses. B, Postcoil embolization (dashed black arrow) reveals complete occlusion of the direct fistula.
- Fig 3.
A, Selective left external carotid injection at 4-month follow-up reveals a dAVF (black arrow) fed by the posterior auricular artery with drainage into the sigmoid sinus. B, Superselective injection of the posterior auricular artery confirms the arterial supply to the dAVF (dashed black arrow). C, Postembolization run from the left external carotid artery confirms the obliteration of the fistula.
Tables
Summary of case reports of de novo fistulas after transvenous embolization of a carotid cavernous fistula
Study CCF Feeder CCF Drainage Treatment Months Remote Fistula Developed New Fistula Location Nakagawa et al, 1992 (4) Branches of left ECA and ICA Bilateral SOV, IPS Transarterial occlusion of ECA branches and transvenous occlusion of SOV and IPS 6 Ascending pharyngeal to transverse sinus Kubota et al, 1999 (7) Branches of left ECA and bilateral ICA Left SOV Transvenous embolization of SOV 4 Occipital and ascending pharyngeal to jugular bulb Yamashita et al, 1993 (5) Right ECA branches and right ICA Right IPS and right SOV Transarterial occlusion of ECA branches and transvenous occlusion of IPS 12 Occipital and ascending pharyngeal to transverse sinus Kawaguchi et al, 1999 (6) Left ECA and left ICA Left IPS Transvenous occlusion left of IPS 30 Occipital, postauricular, internal maxillary artery to transverse sinus Makiuchi et al, 1998 (9) Left ECA and left ICA IPS and SOV Transvenous occlusion of left IPS – ECA branches to transverse sinus Kiyosue et al, 2002 (8) Left ECA and left ICA Left SOV Transvenous occlusion of left SOV 5 Ascending pharyngeal and occipital to jugular bulb Note.—CCF indicates carotid cavernous fistula; ECA, external carotid artery; ICA, internal carotid artery; SOV, superior ophthalmic vein; IPS, inferior petrosal sinus.
