Regression of an internal carotid artery pseudoaneurysm after therapeutic embolization of a post-traumatic carotid-cavernous fistula secondary to gunshot injury

Abstract

A case is reported of a 53-year-old woman who was hit by a bullet which penetrated the skull base and caused a left carotid-cavernous fistula of the direct type and a pseudoaneurysmal dilation of the high cervical portion of the left internal carotid artery. The fistula was successfully embolized by positioning a balloon into the fistula itself by means of the Debrun technique: unexpectedly the size of the pseudoaneurysm decreased after the embolization; the possible explanations for this event are discussed.

Spontaneous Thrombosis of a High-Flow Carotid-Cavernous Fistula after Failed Transarterial Balloon Occlusion

“…Rupture of a preexisting small aneurysm, triggered by the rupture caused by the trauma, may also have occurred. However, the small aneurysm decreased in size one year later, indicating that it was not a true aneurysm but a pseudoaneurysm 14 . Endovascular closure is the treatment of choice in direct CCF.…”

Spontaneous Occlusion of Traumatic Carotid Cavernous Fistula with Pseudoaneurysm Formation-management with Neuroform Stent and Coiling: A Case Report

“…The exact mechanism of spontaneous occlusion of CCF in this case is uncertain, but the thrombogenicity of contrast media and the catheterization precedure itself could be related with the occlusion of shunts. The natural history of pseudoaneurysm after spontanous occlusion of traumatic CCF is controversial 4,9,11,12,16,18,19,22) . Even though spontaneous regression could be possible, they also could cause cerebral embolism and ischemic event, enlargement and recanalization 22) .…”

“…The natural history of pseudoaneurysm after spontanous occlusion of traumatic CCF is controversial 4,9,11,12,16,18,19,22) . Even though spontaneous regression could be possible, they also could cause cerebral embolism and ischemic event, enlargement and recanalization 22) . In our case, the psueudoaneurysm enlarged significantly after two months which was managed neuroform 2) stent assisted coiling suscessfully 1,3,6,14) .…”