Transarterial embolization of carotid-cavernous sinus fistula associated with a primitive trigeminal artery-case report

BACKGROUND AND PURPOSE We evaluated our experience in placing detachable coils in the management of spontaneous CCFs due to rupture of a primitive trigeminal artery. Methods A 48-year-old female presented with right conjunctival chemosis and right abducens nerve paresis. Cerebral angiography demonstrated a right carotid-cavernous sinus fistula associated with persistent primitive trigeminal artery. Transvenous routes to the sinus were failed due to the tortuous facial vein. The fistula was treated by Matrix detachable coils and Fibered detachable coils through the transarterial approach. Results The patient was successfully treated by means of transarterial embolization, and symptoms improved within a week. Conclusions Although other techniques using a transvenous approach may also be useful, transarterial embolization with detachable coils should be a safe and effective method to immediately occlude the fistula.