Usefulness of Intravascular Ultrasonography Monitoring of Coil Embolization for Traumatic Direct Carotid-Cavernous Fistula —Case Report—
Neurol Med Chir (Tokyo) 49, 604¿607, 2009 Usefulness of Intravascular Ultrasonography Monitoring of Coil Embolization for Traumatic Direct Carotid-Cavernous Fistula —Case Report— Akimasa NISHIO, Taichiro KAWAKAMI,YutakaMITSUHASHI,KojiHAYASAKI*, Miki KIYAMA**,YuichiTADA**,andKenjiOHATA Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka; *Department of Neurosurgery, Saiseikai Ibaraki Hospital, Ibaraki, Osaka; **Department of Neurosurgery, Ouekai Katsuragi Hospital, Kishiwada, Osaka Abstract A 61-year-old woman was admitted for head injury after a traffic accident. Two months later, she devel- oped abducens nerve palsy, chemosis, and pulsatile tinnitus. Right internal carotid angiography demonstrated a high flow direct carotid-cavernous fistula (CCF) at the C5 portion with reflux into the su- perficial and deep sylvian veins, superior ophthalmic vein, superior petrosal sinus, and inferior petrosal sinus. Intravascular ultrasonography (IVUS) revealed a large fistula at the C5 portion of the in- ternal carotid artery (ICA). Coil embolization via transarterial and transvenous approaches under IVUS monitoring was performed. During the procedure, IVUS accurately detected protrusion of a coil into the parent ICA, and the parent artery could be preserved. IVUS monitoring is useful for embolization of direct CCF with coils. Key words: direct carotid-cavernous fistula, embolization, intravascular ultrasound Introduction paresis. In addition, the coil mass may protrude into the parent artery through the large tear or may obscure the Direct carotid-cavernous fistulas (CCFs) are preferably relationship between cavernous sinus and the nearby par- treated via a transarterial approach, ideally resulting in ent artery, with increased risk of occluding the parent ar- permanent occlusion of the fistula and preservation of the tery.
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