Common carotid intimamedia thickness and risk of stroke. Carotidcavernous sinus fistulae ccf are extremely rare and can be classified as traumatic or spontaneous, direct when the fistula is directly off of the internal carotid artery ica or indirect when the fistula is from a branch of the ica and low or high flow. A 46 yearold man was seen in the emergency department complaining of carotid cavernous sinus. Injury to the internal carotid artery causes blood to flow directly to the cavernous sinus at a higher rate than normal, resulting in redness, swelling and pain around the affected eye. The cortical venous drainage from carotidcavernous fistula ccf is associated with increased risk of intraparenchymal hemorrhage and may be the clue for the urgent indication of an endovascular treatment. Barrow classification of caroticocavernous fistulae. As arterial blood under high pressure enters the cavernous sinus, the normal venous return to the cavernous sinus is impeded and this causes engorgement of the draining veins, manifesting most dramatically as a. Recurrent neurosensory macular detachment in carotid cavernous. Carotid cavernous fistula with bilateral thalamic infarct jeremy was suffering from a carotid cavernous fistula an abnormal connection between two blood vessels in his skull which impaired his vision and restricted his ability to.
Outcome of carotidcavernous fistula embolization with. Traumatic carotidcavernous fistula presenting as massive. Carotidcavernous fistula an overview sciencedirect topics. Carotid endarterectomy and carotid artery stenting are among the most common peripheral vascular procedures performed worldwide. Four cases in which the diagnosis of carotidcavernous fistula was made by using ct angiography are illustrated. The treatment of a carotid cavernous fistula ccf depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. From 1986 to the end of 1998, 482 cases of traumatic carotidcavernous fistula tccf were treated by means of intravascular embolisation technique. Carotid cavernous fistula patients typically present with proptosis, elevated intraocular pressure, prominent tortuous conjunctival vessels, and sometimes headache. In most instances, endovascular treatment is preferred.
The most frequent are type c, with meningeal branches of the external carotid forming the fistula 3. A sheath is placed in the femoral artery in the groin, and a catheter is used to obtain a cerebral angiogram. As a result, the blood can drain properly from the eyes. Carotidcavernous fistula may result from the down fracture of the maxilla or the pterygoid osteotomy, thus injuring the internal carotid artery.
A duct or passage resulting from injury, disease, or a congenital disorder that connects an. Carotid duplex ultrasound cdu is a commonly performed vascular exam. Peng and others published carotid cavernous fistula presenting with bilateral abducens palsy find, read and cite all the research you need on researchgate. A 53yearold male with bilateral carotid occlusion and a. Carotid cavernous sinus fistula carotid artery cavernous. B, left internal carotid angiogram, lateral view, showing a dural arteriovenous fistula at the posterior cavernous sinus. A 45yearold caucasian male presented to the emergency department of a tertiary care. The difference in the blood pressure between the arteries and the veins behind the eye leads to a buildup of blood in a persons eye. Surgical venous drainage disconnection from cavernous. Ccfs are classified into two main types based on their pathophysiology, direct type a and indirect type bd 1, 2, as shown in figure 1. A carotid cavernous sinus fistula is such a channel, that is formed between the carotid artery, one of the major arteries of the body, and the cavernous sinus, a venous sinus that lies within the head. Caroticocavernous fistula radiology reference article. Highflow direct ccfs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. Treating a carotid cavernous fistula with embolization involves placing small platinum coils where the abnormal connection is.
The diagnosis was confirmed by digital subtraction angiography in all four instances. Occlusion of the extracranial carotid arteries adam e. Posterior scleritis mimicking indirect carotidcavernous fistula. Pdf download for occlusion of the extracranial carotid arteries. However it is difficult to infer direction of venous drainage from the clinical signs or symptoms of a patient with ccf. Doctor answers on symptoms, diagnosis, treatment, and more. Many kinds of detachable balloon catheters including chinese made detachable balloon catheters, coils and cyano aery late were used as embolic materials. Arteriosclerosis, thrombosis, and vascular biology atvb. Picture of women at the rehabilitation centre in kano, taken after consent. Epistaxis related to internal carotid artery cavernous. Carotid cavernous fistulas and dural arteriovenous fistulas of the cavernous sinus.
Unlike indirect fistulas, which often have a relatively indolent course, indications for treating direct ccfs are dictated by rapidly progressive symptoms especially increased intraocular pressure and decline in vision, previous intracranial hemorrhage or epistaxis, and disabling bruit. Carotidcavernous fistula kennerdell case 26, ppt creator john s. Carotidcavernous fistulas ccfs are abnormal communications between the carotid arterial system and the venous cavernous sinus. A carotidcavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. Thematic evaluation of national programmes and unfpa. A carotidcavernous fistula is a vascular disorder in the cavernous sinus region of the skull. A carotidcavernous sinus fistula is an abnormal connection that forms between a carotid artery in your neck and the network of veins at the back of your eye. The diagnostic angiography demonstrated a right ccf. Carotidcavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein.
Carotid endarterectomy pdf veterans health library. The usefulness of the source images of magnetic resonance. This results in shortcircuiting of the arterial blood into the venous system of the cavernous sinuses. Carotid cavernous fistulas ccfs are a rare but potentially devastating cause of orbital symptoms, visual loss, and periocular disfigurement. Internal carotid artery ica stenosis quantification is essential for the clinical management of patients, since several trials have concluded that. There were prominent choroidal folds which were seen more obviously with the red free light. Advances in the endovascular treatment of direct carotid. Surgery carotid fistula embolization surgery beaumont. Traumatic carotid cavernous fistula accompanying basilar skull fracture.
Sonographic evaluation of complications of extracranial carotid. He also complained of headache, diplopia dural arteriovenous. Patterns of the internal and cerebral carotid arteries in various avian. A free powerpoint ppt presentation displayed as a flash slide show on id.
A 59yearold woman presented with headache, right pulsatile tinnitus, and diplopia on the right side. However, it was constituted by only the left caudal ramus on the pheasant, silver pheasant, and turkey. Treatment of carotid cavernous fistulas northwestern. A ccf can be due to a direct connection between the cavernous segment of. To our knowledge, this is the first report of the ct angiographic appearance of carotidcavernous fistulas. They are postulated to occur secondary to cavernous sinus thrombosis with revascularization and thus. The carotid artery, the main supply to the head, can establish a direct connection to the veins in the cavernous sinus lead to pronounced elevation of pressure in the veins which will dilate throughout the front of the head and can lead to a deadly leak. Carotidcavernous fistula how is carotidcavernous fistula abbreviated. In carotid artery screening, individuals who have no signs or symptoms of. Kennerdell, md, chair, department of ophthalmology, allegheny general hospital professor, ophthalmology, drexel university. Type 2 diabetesassociated carotid plaque burden is.
On the 60th postoperative day he was free of chest pain and remained neurologically stable. Enlarged cavernous sinus with a convex shape to the lateral. Carotidcavernous fistulas ccfs are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. Traumatic ccf are by far the most common type, accounting for up to 75% of all ccf. An approach via the internal jugular vein and inferior petrosal sinus was possible in 90% of patients, with complete occlusion of the fistula in 81. The cavernous segment of the carotid artery is unique, as it is the only anatomical location in the body where an artery is completely surrounded by a venous structure. Pdf download for carotid artery ultrasound image analysis. Transvenous embolization of dural carotid cavernous. Aggressive change of a carotidcavernous fistula in a. A carotid cavernous fistula ccf is an abnormal passage between the venous cavernous sinus and the internal carotid artery. Carotidcavernous sinus fistulae occur because of traumatic or spontaneous rents in the walls of the intracavernous internal carotid artery or its branches. The authors report a rare case of a carotidcavernous fistula ccf secondary to ehlersdanlos syndrome eds type iv which showed an aggressive angiographical change.
Carotid artery disease can be very serious because it can cause a stroke, or. Based on this classification, our case belongs to type a ii. Ccfs arise from abnormal communications between the carotid arteries and the cavernous sinus. Drainage is toward the ips and the contralateral ips through the intercavernous sinus. Bilateral common carotid artery occlusion ccao is a rare vascular disease. Treatment of carotid cavernous fistulas springerlink. Carotid cavernous fistula ccf is an abnormal communication between the cavernous sinus and the carotid arterial system. Trauma generally triggers the development of direct carotidcavernous fistulae.
With increasing use of invasive diagnostic and interventional procedures in cardiovascular disease, it is important to fi nd out type and frequencies. The external carotid arteries supply oxygenrich blood to your face, scalp, and neck. Presentation and treatment of carotid cavernous aneurysms. It may be a result of trauma to the head, or it may develop spontaneously, particularly in middleaged women. Indirect fistulas are due to communication by multiple branches between the internal andor external carotid arteries and the cavernous sinus. Liang w, xiaofeng y, weiguo l, wusi q, gang s, xuesheng z. Carotid cavernous fistula ccf is an abnormal communication between cavernous sinus and carotid arterial system. Short telomeres are associated with increased carotid. Data from 163 treated hypertensive men who were volunteers for a free medical. Barrow caroticocavernous fistula classification divides caroticocavernous fistulas into direct type a or indirect types bd. The internet journal of ophthalmology and visual science. Recurrent neurosensory macular detachment in carotid.
Carotidcavernous fistula presenting with bilateral. The characteristic clinical features seen in patients with ccfs are. Pdf carotidcavernous fistula in the emergency department. A case of communicating carotidcavernous sinus fistula ccf after minor closed head injury is presented. Diagnostic vascular ultrasonography with the help of color doppler. These first five cta images of the head demonstrate filling of the left cavernous sinus in the arterial phase and asymmetric enlargement and filling of the left superior ophthalmic vein. Carotid cavernous fistulae ccfs are spontaneous or acquired communications between the carotid artery and the cavernous sinus. Carotid stenosis, carotidcavernous fistula, minimal symptom, covered stent. Carotidcavernous fistula ccf is an abnormal communication between the carotid artery ca and cavernous sinus cs. Pdf anomalous branching pattern of the external carotid artery in. A, left external carotid angiogram, anteriorposterior view, showing shunt flow into the left cavernous sinus. Signs and symptoms are related to the compression of structures within the cavernous sinus, including the. The macula was involved with the loss of foveal reflex figure 3. Carotid fistula embolization is accomplished by endovascular closure of the fistula.
This pdf is available for free download from a site hosted by medknow publications. This separates the blood flow of the carotid arteries from that of the veins. What is a carotid cavernous fistula doctor answers. Ctaguided outflowtargeted embolization of direct carotidcavernous fistula duration. If detected early, the condition can be easily treated with an endoscopic procedure, but if left untreated it can eventually lead to blindness.
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