Transradial Comaneci-assisted coiling of a direct carotid-cavernous fistula

Abstract

Direct carotid-cavernous fistula is a communication between the internal carotid artery and the cavernous sinus, most of the times established following trauma or rupture of a cavernous aneurysm. The most commonly used treatments (coils, detachable latex balloons, stents, or liquid agents) carry ischemic or hemorrhagic risks, related to hemodynamic diversion of cerebral blood flow or permanent dual antiplatelet therapy. We report a case of coiling of a carotid-cavernous fistula assisted by the Comaneci, a temporary adjustable bridging mesh (Rapid Medical, Israel), to avoid transarterial or -venous migration. In our experience, Comaneci-assisted coiling represents a feasible solution to maintain patency of the distal vessels during coiling and avoid dual antiplatelet medications, even using a transradial approach.

Endovascular Treatment of a Direct Carotid Cavernous Sinus Fistula with the Woven EndoBridge Aneurysm Embolization System

“…Caused by the arterialization of the superior ophthalmic vein and venous congestion, clinical presentations of direct CCF include acute proptosis, chemosis, headache, and visual impairment due to nerve palsy [1][2][3][4]. The most common treatment of choice is endovascular transvenous embolization with coils or embolic material [5]. This article presents a case of direct CCF caused by a ruptured cavernous aneurysm treated with a Woven En-doBridge (WEB) device (MicroVention, Tustin, CA, USA).…”