Endovascular parent artery sacrifice in giant pseudoaneurysms of cavernous carotid fistula: Report 2 cases

Abstract

Introduction: Cavernous carotid artery fistula (CCF) with giant pseudoaneurysm is very rare according to world medical literature. We reported 2 rare cases of CCF with giant pseudoaneurysm in the cavernous sinus fistula, successfully treated with endovascular intervention (ET) at Cho Ray Hospital. Case 1 is a 38-year-old male patient with a 20-year history of trauma who was admitted to the hospital because of an acute headache. The CT/DSA image was of the right ICA with giant pseudoaneurysm dilatation in the cavernous sinus fistula, the size # 61.9x57.8x56.7 mm , large dilated cortical veins, and especially the fistula that supplies blood through the contralateral anterior and posterior communicating arteries, while the right ICA is chronically occluded at its origin. ET approached the fistula from the vertebral artery through the right posterior communicating artery into the fistula, completely occluding the fistula with coils, preserving the internal carotid artery above the fistula. Case 2 is a 20-year-old male patient, with a history of trauma for 1 year, and was admitted to the hospital because of a epistaxis. The MRI/DSA image is of the right ICA with giant pseudoaneurysm dilatation in the right maxillofacial sinus area, size # 98.8x87.7x96.7 mm, with a small pseudoaneurysm next to the fistula site, with thrombus occupying the majority inside pseudoaneurysm. Doing a carotid artery occlusion test on the same side of the pseudoaneurysm revealed good anterior and posterior communicating arterial collaterals. ET approached the occlusion position right at the fistula and the internal carotid artery with coils. Both cases had good outcome afer ET and were discharged from the hospital 3 days later.