J Cerebrovasc Endovasc Neurosurg.  2023 Sep;25(3):306-310. 10.7461/jcen.2023.E2022.06.005.

Parent artery occlusion of a giant internal carotid artery pseudoaneurysm-related direct carotid cavernous fistula: A case report

• Andreev A
• McMillan N
• Money K
• Shutran M
• Ogilvy C

• KMID: 2546167
• DOI: http://doi.org/10.7461/jcen.2023.E2022.06.005

Abstract

Traumatic internal carotid artery injuries can produce direct carotid-cavernous fistulas as well as giant internal carotid artery pseudoaneurysms. Clinical sequelae can include headaches, cranial nerves palsies, proptosis, chemosis and optic neuropathy with visual loss as the most dangerous complication. Herein, we present a case of one of the largest reported internal carotid artery pseudoaneurysms associated with a direct carotid cavernous fistula. We describe the techniques and pitfalls of treatment with parent vessel occlusion.

Keyword

Internal carotid artery; Carotid-cavernous sinus fistula; Carotid artery injuries

Figure

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  Fig. 1. Initial MRI demonstrating giant right internal carotid artery pseudoaneurysm with severe mass effect on the adjacent temporal lobe, and effacement of the right lateral ventricle. MPRAGE, coronal view.

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  Fig. 2. (A) Initial right ICA angiogram demonstrating giant carotid pseudoaneurysm and direct CCF (asterisk) with no visible flow beyond the cavernous segment. (B) Right CCA angiography following coiling and occlusion of the ICA (arrow) with persistent pseudoaneurysm filling. (C) Right CCA (arrowhead) angiogram at one month demonstrating residual filling of pseudoaneurysm via external carotid artery collaterals. (D) Final ECA angiogram demonstrating spontaneous occlusion of the pseudoaneurysm. ICA, internal carotid artery; CCF, carotid cavernous fistula; CCA, common carotid artery; ECA, external carotid artery

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  Fig. 3. Initial right vertebral artery angiogram demonstrating reconstitution of the ICA by the posterior communicating artery. ICA, internal carotid artery

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