Clinical Trial Summary
Carotid-cavernous fistula (CCF) refers to an aberrant arteriovenous communication between the
carotid arterial system and the venous compartments of the cavernous sinus (CS) Direct CCFs
are when there is a direct fistulous connection between the cavernous sinus and cavernous
segment of the internal carotid artery (ICA), it is called direct or type-A CCF and occur
secondary to a traumatic tear in the artery from a skull base fracture, from the
acceleration-deceleration force of a traumatic injury, or from an iatrogenic injury following
an endovascular intervention or a trans-sphenoidal procedure. They can also occur
spontaneously following an ICA aneurysm rupture or weakening of the arteries from a genetic
condition with subsequent development of chemosis, proptosis, bruit, headache, and/or gradual
decrease in vision either unilaterally or bilaterally. High incidence of motor car accidents
in Egypt carries a relative high incidence of carotid cavernous fistula. Since direct (type
A) CCFs are high flow fistulas with acute/ subacute presentation and may cause serious
complications, such as permanent vision loss or intracranial hemorrhage, they have to be
treated early. CT orbit and MRI often help to confirm the initial diagnosis of CCF
demonstrating extraoccularmuscleenlargement,dilatationofoneorbothsuperiorophthalmic veins and
enlargement of the affected cavernous sinus.Because of its high spatial and temporal
resolution ; the gold standard for evaluation of CCF is digital subtraction angiography; but
currently CT angiography is the non invasive modality of choice for its evaluation
.Previously surgical intervention included suturing or clipping the fistula, packing the
cavernous sinus or ligating the internal carotid artery procedures .Currently endovascular
management is the main stay of treatment for patients that fail or not suitable for
conservative management and compression therapy. Significant advances in stent and catheter
design now make it possible in many instances to deploy covered stents , detachable balloons,
detachable coils, both detachable balloons and coils , both detachable and push coils ,
parent arterial occlusion and using of embolizing materials depending on availability,
patient's affordability, type of fistula, and ease of use.Trans femoral catheterization is
the main approach. However, trans-radial approach will be considered in patients with
advanced iliofemoral diseases
