Carotid-Cavernous Fistula (CCF)

An uncommon but unique subgroup of AVMs. They can be separated into two categories direct and indirect. A direct CCF has connections between the carotid artery and the veins of the cavernous sinus (usually due to trauma or ruptured aneurysm). An indirect CCF usually occurs spontaneously. It is an abnormal connection in which small arterial branches supply the veins. Both types threaten vision as well as eye movement and both conditions can result in major stroke.

Treatments

Balloon occlusion with detachable balloons

A procedure used to treat direct CCF by closing the opening between artery and vein. The approach requires catheterization from the arterial side and occasionally catheterization from the venous side as well. Catheters must be navigated into the region of the abnormal connection and the opening is then closed off with a detachable balloon.

Coiling

This procedure involves the use of a soft platinum micro-coil that is inserted in a micro catheter through the femoral artery and threaded through to the carotid artery to reach the CCF. After being properly positioned, the coil is released into the fistula by a very low voltage current. Once detached and in place, the coil fills the fistula, isolating it from circulation and thereby reducing the pressure and the likelihood of a rupture and a hemorrhagic stroke.

Stenting

This procedure involves a stent (a small flexible cylindrical mesh tube) that is inserted in a micro catheter through the femoral artery and threaded through to the carotid artery to reach the CCF. The stent redirects the blood flow into the carotid artery and patches the abnormal communication between the artery and the vein.