Crowe Jonathan R, Regenhardt Robert W, Dmytriw Adam A, Vranic Justin E, Stapleton Christopher J, Patel Aman B
Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA.
Brigham and Women's Hospital, Department of Neurology, 75 Francis Street, Boston, MA.
J Cerebrovasc Endovasc Neurosurg. 2024 Dec;26(4):394-398. doi: 10.7461/jcen.2024.E2023.05.001. Epub 2024 Mar 25.
We report a case of a 24-year-old patient who presented after a head trauma with a traumatic occlusion of his left internal carotid artery. He underwent diagnostic cerebral angiogram and was found to have a direct left carotid-cavernous fistula (CCF) with retrograde filling from the posterior circulation across the posterior communicating artery. Because of the severe injury to the left internal carotid artery (ICA), reconstructive repair of the ICA was not possible. The patient underwent deconstructive repair of the CCF by coil embolization using a posterior retrograde approach. Coils were successfully placed in the cavernous sinus and back into the left ICA with complete cure of the CCF and restoration of cerebral perfusion distal to the treated CCF. We review the types of CCFs, their clinical presentation, and their endovascular treatments. Retrograde access of a direct CCF is rarely reported in the literature, and we believe this approach offers a viable alternative in appropriately selected patients.
我们报告一例24岁患者，该患者因头部外伤后出现左颈内动脉创伤性闭塞。他接受了诊断性脑血管造影，发现存在直接的左侧颈内动脉海绵窦瘘（CCF），后循环经后交通动脉逆行充盈。由于左颈内动脉（ICA）严重损伤，无法对ICA进行重建修复。该患者采用经后逆行入路，通过弹簧圈栓塞对CCF进行了去构性修复。弹簧圈成功置入海绵窦并回到左侧ICA，CCF完全治愈，治疗的CCF远端脑灌注得以恢复。我们回顾了CCF的类型、临床表现及其血管内治疗方法。文献中很少报道直接CCF的逆行入路，我们认为这种方法为适当选择的患者提供了一种可行的替代方案。
