Carotid-cavernous fistulas are a type of abnormal connection of the arteries directly into cavernous sinus (vein). Generally patients present with proptosis (bulging of the eye) and pain around the affected eye. Ninety percent of the time, patients have experienced a trauma in the past. These symptoms are a result of increased blood flow and pressure from the arteries to the veins in this region. It is important to treat this to avoid vision problems, as venous pressure will eventually lead to blindness.
Carotid fistula embolization is accomplished by endovascular closure of the fistula. This is a done under general anesthesia. A sheath is placed in the femoral artery in the groin, and a catheter is used to obtain a cerebral angiogram. Treatment options may include packing of the cavernous sinus with platinum coils. Balloon assisted reconstruction or stent may be considered. Patients are usually followed in the neuro intensive care unit. Other teams involved in the care of these patients may include the neurosurgery, neurology and ophthalmology services.