Endovascular transvenous treatment of carotid–cavernous fistula

Carotid–cavernous fistulas represent abnormal communication between the carotid circulation and the cavernous sinus. They can be classified as direct or indirect. The Barrow classification is the most widely used system that categorizes the carotid–cavernous fistulas based on their arterial supply (type A–D). The mainstay of therapy for carotid–cavernous fistulas consists of transarterial or transvenous embolization, while other treatment options such as open surgery or radiosurgery are still utilized as second-line or adjuvant therapeutic options. We present the case of a 72-year-old female patient with conjunctival chemosis and exophthalmos. Computed tomography angiography detected a carotid–cavernous fistula that was confirmed with catheter angiography (Barrow type C). Through right femoral vein catheterization, detachable coils were deployed in the right cavernous sinus, adjacent to the fistula shunt point. The procedure was completed with N-butyl cyanoacrylate injection (dilution 1:2). At post-procedural digital subtraction angiography, the fistula was excluded. Endovascular transvenous treatment is a valid therapeutic option for indirect carotid–cavernous fistulas.