CAROTID-CAVERNOUS FISTULA (CCF)

Q1 What is Carotid-Cavernous Fistula (CCF)?

CCF is direct connection between cavernous part of Internal carotid artery (ICA) and Cavernous sinus. It drains into cavernous sinus tributaries. So arterial pressure from ICA is directly transmitted to cavernous sinus tributaries like ophthalmic veins and cerebral veins.

Q2 How patients with CCF presents?

Patients with CCF presents with:
1. Eye proptosis, redness, loss of vision
2. Occasionally venous hypertension, raised intracranial pressure and intracranial hemorrhage

Q3 What are indications for treating CCF?

All CCF should be treated

Q4 How to treat CCF?

Endovascular embolization is treatment of choice.

Q5 How CCF embolization is done?

Step 1: Femoral artery is punctured and sheath is placed in femoral artery. Then through it guiding catheter (green) is placed into neck vessel.

Step 2: Through the guiding catheter balloon catheter (purple) is taken in ICA across the rent and microcatheter (yellow) is taken in cavernous sinus.

Step 3: Balloon is inflated to protect ICA and CCF is embolized with coils and liquid embolic agent.

Step 4: After fistula is obliterated (keeping ICA patent), finally microcatheter, balloon catheter, guiding catheter and sheath are removed.

CASE: 13yrs male with history of Road Traffic Accident presented with right eye redness and swelling, Right Carotid-Cavernous Fistula