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Abstract - Case Report

J Cerebrovasc Endovasc Neurosurg. 2021 23(1): 54-59
The Journal of Cerebrovascular and Endovascular Neurosurgery
Is the retrograde access for endovascular treatment of a traumatic carotid cavernous fistula associated with dissection of the ipsilateral carotid possible?
Bruno Amaral1, Celso Saito1, Darcio Nalli1, Henrique Carrete Junior1, Michel Frudit1
1Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil 2Department of Interventional Neuroradiology, Hospital Estadual Central, VitÓria ES, Brazil

This is a case demonstrating a combined traumatic lesion of the internal carotid artery (dissection and a carotid cavernous fistula [CCF]) in a patient who was beaten during a robbery and, while trying to escape, was hit by a vehicle. Endovascular approach for the treatment was chosen using the retrograde access from the vertebral artery to the cavernous sinus by posterior communicating (Pcom) artery due to the occlusion of the ipsilateral internal carotid. Because the artery access by the internal carotid was impossible, retrograde approach by vertebral artery and Pcom artery was done to treat the direct CCF. A patient presented with left hemiplegia and proptosis, chemosis, right eye ptosis. Computed tomography (CT) and CT angiography revealed a CCF of the right carotid. An arterial retrograde endovascular approach by the vertebral artery was used for CCF occlusion with coils. We present a rare case of a combined traumatic cerebrovascular lesion, right carotid artery dissection and a right direct CCF treated by a retrograde endovascular approach by the vertebral artery through the Pcom artery to reach the fistula point and achieved a complete cure of the CCF.
Key words : Carotid-cavernous sinus fistula, Carotid artery, Internal, Dissection, Endovascular procedures

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