Bilateral Persistent Pharyngo-Stapedial Arteries Revealed during Evaluation of a Carotid-Cavernous Fistula. 3 Tesla MR Angiographic Aspects.

A 33-year-old woman was evaluated for a right carotid-cavernous fistula revealed by a proptosis and chemosis of the right eye. The initial angiogram showed a left persistent pharyngo- stapedial artery (Ph-SA). A temporal bone CT suggested bilateral pharyngo-stapedial artery persistence. The right Ph-SA was not opacified in the first angiogram because of the high degree of shunting in the fistula. Four months later the patient was admitted for treatment of the carotid-cavernous fistula. In the meantime, the fistula had altered, with spontaneous thrombosis of the ophthalmic vein, and decrease of the vascular steal, explaining that the right Ph-SA was clearly visible on the angiogram performed during the procedure. The carotid-cavernous fistula was completely occluded with five detachable coils. The followup included 3 Tesla MR angiography that showed complete closure of the fistula with preservation of the right ICA and bilateral persistent pharyngo-stapedial arteries.