Abstract
Abstract Carotid cavernous fistula (CCF) is a rare complication of surgical procedures. Single case reports have been published in association with carotid endarterectomy (CEA). We hereby present a case of a 75 years old woman who was admitted to our hospital with complaints of intense headache, bilateral visual disturbance and proptosis one month after elective CEA. CT angiography demonstrated a right side CCF. Digital subtraction angiography (DSA) showed a direct high-flow fistula with subtotal vascular steal phenomenon on the right side. Initial endovascular occlusion was partial but gave almost total relief of all symptoms. A few weeks later a second procedure was necessary due to recurrence of ocular symptoms and headache. This time complete occlusion of the fistula was achieved. The patient had episodic headaches at follow-up 9 months later. Follow-up DSA demonstrated a complete fistula occlusion and normal filling of distal cerebral vessels. This is a case to illustrate a rare complication of carotid artery surgery. The patient had atherosclerotic vessel damage of ICA visible on earlier CT scans. This combined with abrupt increase of transmural pressure due to the revascularization procedure could possibly lead to arterial wall rupture and fistula formation.
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