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.
Patients with CCF presents with:
1. Eye proptosis, redness, loss of vision
2. Occasionally venous hypertension, raised intracranial pressure and intracranial hemorrhage
All CCF should be treated
Endovascular embolization is treatment of choice.
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