Concomitant occurrence of clinoid and cavernous segment aneurysms complicated with carotid cavernous fistula: A case report

We present a case of complex concomitant occurrence of a CSA and a CCA complicated with delay aneurysmal rupture (DAR) resulting in carotid cavernous fistula (CCF) after our initial treatment of the patient with pipeline embolization devices (PLEDs) Patient Concerns: We present a 64-year old female who we admitted at our institution due to one-year history of double vision. Neurological examinations were unremarkable. Diagnosis: Magnetic resonance imaging (MRI) and computer tomography (CT)-scan revealed dual aneurysms on the ICA. Digital subtracting angiogram (DSA) confirmed a small CSA and a large CCA on the right ICA. Interventions: We treated both aneurysms with PLED and subsequently observed DAR of CCA as a complication. Outcomes: We successfully occluded the fistula with ONYX (ev3, Irvine, CA) via the trans-venous approach. Lesions: PLED was the best endovascular treatment option though DAR was inevitable. Although the trans-arterial approach may be the gold standard for the managing of CCF, the complex nature of our case made us opt for trans-venous approach. The trans-venous route is very appropriate for fistulas with complex parent arteries.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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